A. Abiola1, A. Schneider1, M. Phillips1, L. Pascarella1, S. McLean1, A. Charles1, A.C. Akinkuotu1 1University Of North Carolina At Chapel Hill, Surgery, Chapel Hill, NC, USA
Introduction:
Pediatric blunt cerebrovascular injuries (BCVI) are rare and associated with neurological deficits and death. Diagnosis of BCVI is often made by CT angiography of the neck. Risk factors for BCVI and indications for CTA imaging in children remain unclear. Using a national database, we sought to identify demographic and injury characteristics associated with CTA and outcomes of BCVI in children.
Methods: We performed a retrospective review of all pediatric patients (≤15 years) in the National Trauma Databank from 2016- 2021. Patients were included if they had a blunt mechanism of injury. We performed a multivariate regression analysis to identify factors that were independently associated with receiving a CTA neck and death following BCVI.
Results: We identified a total of 226,591 patients, of which 7,968 (3.5%) had CTA neck during their initial evaluation. Children who had CTA neck were older (10±4.5 vs.8.5±4.4 p<0.001), more likely Hispanic (22.5% vs. 20.2%; p<0.001), more involved in motor vehicle collision (MVC) (54.8% vs. 24.2%;p<0.001), less likely treated in pediatric hospitals (46.3% vs. 49.2%; p<0.001), with higher injury severity score (ISS) (14±11.9 vs 6.1±5.9;p<0.001), and lower Glasgow Coma Scale (GCS) (15[13-15] vs.15[15-15]) than those without CTA neck. On multivariable regression analysis, non-Hispanic ethnicity (OR: 0.89; 95%CI: 0.83-0.95) and increasing GCS (OR: 0.89; 95%CI: 0.88-0.90), were associated with lower odds of having CTA neck. Treatment at a pediatric hospital (OR: 1.08;95%CI: 1.03-1.14) and increasing age (OR: 1.03; 95%CI: 1.02-1.04) were associated with higher odds of having CTA neck.
A total of 412 patients had BCVI and the majority (67%, n=276) had CTA neck. Children who had BCVI were older (10.6±4.5 vs. 8.5±4.4;p<0.001), more involved in MVC (61.2%% vs. 25.2%; p<0.001), and with higher ISS (27.1±15.4 vs 6.3±6.3;p<0.001) and lower median GCS (10 [3-15] vs. 15[15-15]) than those without BCVI. Table 1 illustrates comparison of children who had CTA neck with BCVI to those without BCVI. Children with CTA neck and BCVI had significantly lower median GCS (8 vs.15; p<0.001), were more often treated at a pediatric hospital (53.3% vs. 46.0%; p=0.004), and significantly higher mortality (11.2% vs. 2.2%; p<0.001)
Although the overall mortality rate was 1.7%, 11.9% (n=49) of children with BCVI died. Factors independently associated with mortality included GCS (OR:0.57; 95%CI:0.46-0.72) and pedestrian mechanism (OR:2.34; 95%CI 1.00-5.47)
Conclusion:
Despite the low incidence of pediatric BCVI, this injury pattern is associated with high mortality. Older children, treated at pediatric hospitals with lower levels of responsiveness were significantly more likely have CT angiography for BCVI evaluation. Future studies are needed to evaluate the utility of CT angiography in guiding the treatment of children with BCVI.