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Analysis of blunt cerebrovascular injury in pediatric trauma

Grigorian, Areg MD; Dolich, Matthew MD; Lekawa, Michael MD; Fujitani, Roy M. MD; Kabutey, Nii-Kabu MD; Kuza, Catherine M. MD; Bashir, Rame; Nahmias, Jeffry MD, MHPE

Journal of Trauma and Acute Care Surgery: December 2019 - Volume 87 - Issue 6 - p 1354–1359
doi: 10.1097/TA.0000000000002511
ORIGINAL ARTICLES
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BACKGROUND Blunt cerebrovascular injury (BCVI) occurs in <1% of pediatric patients. The two principal screening criteria for BCVI in children are the Utah and McGovern Score with motor vehicle accident (MVA) considered to be a predictor for BCVI. We sought to confirm previously reported risk factors and identify novel associations with BCVI in pediatric patients.

METHODS The Pediatric Trauma Quality Improvement Program (2014–2016) was queried for patients younger than 16 years presenting after blunt trauma. A multivariable logistic regression was used to determine risk of BCVI.

RESULTS From 69,149 pediatric patients, 109 (<0.2%) had BCVI. The median age was 13 years, and the median Injury Severity Score was 25. More than half the patients were involved in MVAs (53.2%) and had a skull base fracture (53.2%). Factors independently associated with BCVI include skull base fracture (odds ratio [OR], 3.84; 95% confidence interval [CI], 2.40–6.14; p < 0.001), cervical spine fracture (OR, 3.15; 95% CI, 1.91–5.18; p < 0.001), intracranial hemorrhage (OR, 3.11; 95% CI, 1.89–5.14; p < 0.001), Glasgow Coma Scale score of 8 or less (OR, 2.11; 95% CI, 1.33–3.54; p = 0.003), and mandible fracture (OR, 1.99; 95% CI, 1.05–3.84; p = 0.04). Motor vehicle accident was not an independent predictor for BCVI (p = 0.07).

CONCLUSION In the largest analysis of pediatric BCVI to date, skull base fracture had the strongest association with BCVI. Other associations to pediatric BCVI included cervical spine and mandible fracture. Motor vehicle accident, previously identified to be associated with BCVI, was not an independent risk factor in our analysis. A future multicenter study incorporating newly identified variables in a scoring system to screen for BCVI is warranted.

LEVEL OF EVIDENCE Level IV (Prognostic/Epidemiologic).

From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (A.G., M.D., M.L., R.M.F., N.-K.K., R.B., J.N.), University of California, Irvine, Orange; and Department of Anesthesia (C.M.K.), University of Southern California, Los Angeles, California.

This work was presented at the 90th Annual Meetings of the Pacific Coast Surgical Association, February 15-18, 2019 in Tucson, Arizona.

Submitted: February 17, 2019, Revised: July 31, 2019, Accepted: September 17, 2019, Published online: October 14, 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Areg Grigorian, MD, Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600; Orange, CA 92868-3298; email: agrigori@uci.edu.

Online date: October 16, 2019

© 2019 Lippincott Williams & Wilkins, Inc.