Ruth A Lewit, Todd A Nickoles, Regan Williams, David M Notrica, Rachael L Stottlemyre, Mark Ryan, Jeremy J Johnson, Jessica A Naiditch, Karla A Lawson, Robert Todd Maxson, Sandra Grimes, James W Eubanks
{"title":"Blunt cerebrovascular injury in children: A prospective multicenter ATOMAC+ study.","authors":"Ruth A Lewit, Todd A Nickoles, Regan Williams, David M Notrica, Rachael L Stottlemyre, Mark Ryan, Jeremy J Johnson, Jessica A Naiditch, Karla A Lawson, Robert Todd Maxson, Sandra Grimes, James W Eubanks","doi":"10.1097/TA.0000000000004620","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The incidence of blunt cerebrovascular injury (BCVI) in children remains largely unknown, with only 16.5% of children receiving appropriate screening. This study sought to determine the impact of a screening guideline on injury detection and outcomes in children with BCVI.</p><p><strong>Methods: </strong>This was a prospective, multi-institutional observational study of children younger than 15 years with blunt trauma to the head, face, or neck (Abbreviated Injury Scale score, >0) at any of six level 1 pediatric trauma centers. All patients were screened using the Memphis criteria. Head/neck computed tomography angiogram was recommended for those meeting the criteria. Treatment for BCVI was recommended based on overall trauma burden, with 7- to 10-day follow-up imaging.</p><p><strong>Results: </strong>A total of 2,285 patients met the inclusion criteria. Of those, 520 (23%) (median age, 7.9 years) met the Memphis screening criteria, and 222 (42.5%) received appropriate imaging. A total of 30 BCVIs were identified in 25 patients (1.05%); 22 (88%) had a carotid injury, and 6 (24%) had a vertebral artery injury. Motor vehicle collision was the most common mechanism (42%). Those with BCVIs were older (8.01 years, p = 0.03), with a lower median Glasgow Coma Scale (7.8 vs. 15, p < 0.0001). All but three met the Memphis screening criteria (sensitivity, 88%). Eight (32%) underwent treatment. Six children with BCVI suffered a stroke (24%): two untreated and one treated patient developed a stroke after diagnosis.</p><p><strong>Conclusion: </strong>Similar to adults, BCVI in children screened has an incidence of 1% (overall incidence of 0.33% in all blunt trauma) and carries a significant risk of stroke. Treatment of BCVI in children in this study is inconsistently applied even after diagnosis, and stroke may still occur with treatment.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"245-252"},"PeriodicalIF":3.7000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004620","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/24 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The incidence of blunt cerebrovascular injury (BCVI) in children remains largely unknown, with only 16.5% of children receiving appropriate screening. This study sought to determine the impact of a screening guideline on injury detection and outcomes in children with BCVI.
Methods: This was a prospective, multi-institutional observational study of children younger than 15 years with blunt trauma to the head, face, or neck (Abbreviated Injury Scale score, >0) at any of six level 1 pediatric trauma centers. All patients were screened using the Memphis criteria. Head/neck computed tomography angiogram was recommended for those meeting the criteria. Treatment for BCVI was recommended based on overall trauma burden, with 7- to 10-day follow-up imaging.
Results: A total of 2,285 patients met the inclusion criteria. Of those, 520 (23%) (median age, 7.9 years) met the Memphis screening criteria, and 222 (42.5%) received appropriate imaging. A total of 30 BCVIs were identified in 25 patients (1.05%); 22 (88%) had a carotid injury, and 6 (24%) had a vertebral artery injury. Motor vehicle collision was the most common mechanism (42%). Those with BCVIs were older (8.01 years, p = 0.03), with a lower median Glasgow Coma Scale (7.8 vs. 15, p < 0.0001). All but three met the Memphis screening criteria (sensitivity, 88%). Eight (32%) underwent treatment. Six children with BCVI suffered a stroke (24%): two untreated and one treated patient developed a stroke after diagnosis.
Conclusion: Similar to adults, BCVI in children screened has an incidence of 1% (overall incidence of 0.33% in all blunt trauma) and carries a significant risk of stroke. Treatment of BCVI in children in this study is inconsistently applied even after diagnosis, and stroke may still occur with treatment.
Level of evidence: Prognostic and Epidemiological; Level II.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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