Blunt cerebrovascular injuries in the child

Am J Surg. 2012 Jul;204(1):7-10. doi: 10.1016/j.amjsurg.2011.07.015. Epub 2011 Dec 15.

Abstract

Background: Although blunt cerebrovascular injuries (BCVIs) are a well-recognized sequela of trauma in adults, there have been few reports in children. The investigators questioned whether adult screening protocols are appropriate in the pediatric population. The purpose of this study was to describe the incidence, injury patterns, and stroke rates of pediatric patients sustaining BCVIs.

Methods: Pediatric patients (aged ≤ 18 years) diagnosed with BCVIs at a regional level I trauma center and a pediatric level I trauma center since 1996 were reviewed.

Results: Forty-five patients sustained BCVIs (60% male; mean age, 13 ± .7 years; mean Injury Severity Score, 23 ± 2). Three patients exsanguinated, and 10 presented with stroke; neurologic changes occurred 17 ± 6 hours after injury (range, 1-72 hours). Screening indications were present in 30%. Thirty-two asymptomatic patients were diagnosed. All but 1 received antithrombotic agents; 1 patient had neurologic deterioration despite heparinization. Comparing asymptomatic patients with those with stroke, there was a significant difference in age (15 vs 11 years).

Conclusions: More than two-thirds of patients presenting with stroke did not have screening indications according to adult protocols. With the availability of noninvasive diagnostic imaging such as computed tomographic angiography, broader screening guidelines for children should be instituted.

MeSH terms

  • Accidents, Traffic
  • Adolescent
  • Angiography
  • Anticoagulants / administration & dosage
  • Cardiovascular Agents / administration & dosage*
  • Carotid Artery Injuries / etiology
  • Cerebrovascular Circulation*
  • Child
  • Child, Preschool
  • Colorado / epidemiology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Head Injuries, Closed* / complications
  • Head Injuries, Closed* / diagnosis
  • Head Injuries, Closed* / drug therapy
  • Head Injuries, Closed* / epidemiology
  • Head Injuries, Closed* / physiopathology
  • Heparin / administration & dosage
  • Humans
  • Injury Severity Score
  • Male
  • Platelet Aggregation Inhibitors / administration & dosage
  • Stroke / drug therapy
  • Stroke / etiology*
  • Stroke / physiopathology
  • Stroke / prevention & control
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vertebral Artery / injuries
  • Young Adult

Substances

  • Anticoagulants
  • Cardiovascular Agents
  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Heparin