Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study.
OBJECT Computed tomography angiography (CTA) is frequently used to examine patients for blunt cerebrovascular injury (BCVI) after cranial trauma, but the pediatric population at risk for BCVI is poorly defined. Although CTA is effective for BCVI screening in adults, the increased lifetime risk for malignant tumors associated with this screening modality warrants efforts to reduce its use in children. The authors' objective was to evaluate the incidence of BCVI diagnosed by CTA in a pediatric patient cohort and to create a prediction model to identify children at high risk for BCVI. METHODS Demographic, clinical, and radiographic data were collected retrospectively for pediatric patients who underwent CTA during examination for traumatic cranial injury from 2003 through 2013. The primary outcome was injury to the carotid or vertebral artery diagnosed by CTA. RESULTS The authors identified 234 patients (mean age 8.3 years, range 0.04-17 years, 150 [64%] boys) who underwent CTA screening for BCVI. Of these, 24 (10.3%) had a focal neurological deficit, and 153 (65.4%) had intracranial hemorrhage on a head CTA. Thirty-seven BCVIs were observed in 36 patients (15.4%), and 16 patients (6.8%) died. Multivariate regression analysis identified fracture through the carotid canal, petrous temporal bone fracture, Glasgow Coma Scale (GCS) score of < 8, focal neurological deficit, and stroke on initial CT scan as independent risk factors for BCVI. A prediction model for identifying children at high risk for BCVI was created. A score of ≤ 2 yielded a 7.9% probability of BCVI and a score of ≥ 3 a risk of 39.3% for BCVI. CONCLUSIONS For cranial trauma in children, fracture of the petrous temporal bone or through the carotid canal, focal neurological deficit, stroke, and a GCS score of < 8 are independent risk factors for BCVI.
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine; and.
Vijay M
VM
Ravindra
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine; and.
Jay
J
Riva-Cambrin
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine; and.
Walavan
W
Sivakumar
2Department of Surgery, University of Utah School of Medicine;|3Division of Pediatric Surgery, Primary Children's Hospital, Salt Lake City, Utah.
Ryan R
RR
Metzger
1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah School of Medicine; and.
Robert J
RJ
Bollo
D000293:Adolescent; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
BCVI = blunt cerebrovascular injury; CTA = computed tomography angiography; EAST = Eastern Association for the Surgery of Trauma; GCS = Glasgow Coma Scale; ICA = internal carotid artery; NPTR = National Pediatric Trauma Registry; ROC = receiver operating characteristic; TBI = traumatic brain injury; VA = vertebral artery; cerebrovascular injury; computed tomography angiography; pediatrics; technique; trauma; traumatic brain injury