Blunt Carotid Injuries in trauma
Blunt cerebral vascular injury (BCVI) in children is relatively rare, but the consequences of a missed injury are severe (stroke, pseudoaneurysm, Horner's Syndrome, and death). Recent reviews have quoted a prevalence of 0.03-0.5% in pediatric trauma, with up to 16% of peds trauma patients undergoing imaging to identify such injuries. This retrospective review aimed to identify screening parameters and risk factors for pediatric BCVI.
What did they do? Review of their trauma registry including only patients aged 0-15 admitted primarily (not transferred) with a traumatic injury. Notably, they excluded minor and moderate injuries according to their Abbreviated Injury Scale score (MAIS), but they retroactively went back and looked at all these excluded patients and found no BCVIs.
What did they find? Of the 9,070 included patients (average age 9), 50 had BCVI (prevalence of 0.55%). All BCVI patients had an MAIS >=3 (see below), and higher injury severity scores, indicating that all had severe injuries. Other findings associated with BCVI: head injury, GCS <8, focal neurologic deficit, MVC as mechanism (compared to fall), older age, multiple body regions injured (especially including chest and abdomen), and pre-hospital hypotension. Lastly, BCVI was associated with a 30% mortality in this study, highlighting the severity of the injuries.
Bottom Line: BCVI in pediatric trauma is rare but associated with high morbidity and mortality. It is very important to consider, but also important to decrease unnecessary scans. Pediatric patients with severe mechanisms of blunt injury of the head and neck and other high risk features (focal neuro deficits, multiple systems injured, or GCS <8) should likely undergo imaging.
What did they do? Review of their trauma registry including only patients aged 0-15 admitted primarily (not transferred) with a traumatic injury. Notably, they excluded minor and moderate injuries according to their Abbreviated Injury Scale score (MAIS), but they retroactively went back and looked at all these excluded patients and found no BCVIs.
What did they find? Of the 9,070 included patients (average age 9), 50 had BCVI (prevalence of 0.55%). All BCVI patients had an MAIS >=3 (see below), and higher injury severity scores, indicating that all had severe injuries. Other findings associated with BCVI: head injury, GCS <8, focal neurologic deficit, MVC as mechanism (compared to fall), older age, multiple body regions injured (especially including chest and abdomen), and pre-hospital hypotension. Lastly, BCVI was associated with a 30% mortality in this study, highlighting the severity of the injuries.
Bottom Line: BCVI in pediatric trauma is rare but associated with high morbidity and mortality. It is very important to consider, but also important to decrease unnecessary scans. Pediatric patients with severe mechanisms of blunt injury of the head and neck and other high risk features (focal neuro deficits, multiple systems injured, or GCS <8) should likely undergo imaging.
