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Pediatric cerebrovascular trauma: Incidence, management, and outcomes

      Highlights

      • Penetrating CVT comprises about 30% of all CVT seen in trauma centers and a little more than 2/3rds of all penetrating CVT are owing to firearm injuries.
      • While open procedures are used in a majority of penetrating CVT (85%), endovascular interventions are necessary in more than 60% of blunt CVT and more than 80% of Intracranial CVT.
      • Stroke rates after CVT are around 3%.
      • There are significant demographic differences between bunt and penetrating CVT. Penetrating CVT was seen predominantly in older, African-American (Nearly 50%), and male patients and carried a higher emergency room mortality. Blunt CVT was seen preponderantly in Caucasian patients with private insurance.

      Abstract

      Background

      Pediatric cerebrovascular trauma (CVT) is rare. There is an increasing use of endovascular management in vascular trauma. We studied the incidence, management, and outcomes of CVT in the pediatric population using the NTDB (National Trauma Data Bank).

      Methods

      The NTDB was queried for CVT in patients less than 18 years of age over a recent three-year period (2017–2019). Demographics, injury mechanism, type and location, Glasgow Coma Score (GCS), length of stay (LOS), surgical approach (open vs endovascular), and morbidity/mortality were evaluated. Statistical analysis included χ2 and student's t-tests or Fisher's exact tests where appropriate.

      Results

      Of 386,918 pediatric trauma cases, 1536 (0.4%) suffered 1821 CVT. Blunt trauma accounted for 69.3%. Patients were predominantly male (65.4%) and white (57.5%), with an mean age of 14 years. There were 998 (55%) carotid artery injuries, including 846 common/internal carotid and 145 external carotid. Other vessel injuries included 141 (11%) intracranial carotid, 571 (31%) vertebral artery and 252 (14%) jugular vein. Mean number of vessels injured was 1.2. Motor vehicle trauma was most common (49.3%) followed by firearm injury (21%). The mean GCS was 11, and mean total LOS was 11.3 days. Majority of interventions were performed in an open fashion (65.7%), whereas 29.7% were performed endovascularly. Stroke rate was 3.1%. Patients with multiple vascular injuries had an overall mortality of 29% (p<0.0001).

      Conclusion

      While not accorded as much importance as blunt injury, penetrating CVT comprises of 30% of injuries. Nearly 1/3rd of all cases needing surgical intervention were managed with endovascular techniques.

      Level of evidence

      III.

      Keywords

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