Treatment Practices and Outcomes After Blunt Cerebrovascular Injury in Children.

Neurosurgery 2016 Dec;79(6):872-878

*Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; ‡Department of Neurosurgery, University of Utah School of Medicine, Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah; §Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University, Nashville, Tennessee; ¶Department of Neurosurgery, Washington University in St. Louis, Division of Pediatric Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri; ‖Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas.

Background: Pediatric blunt cerebrovascular injury (BCVI) lacks accepted treatment algorithms, and postinjury outcomes are ill defined.

Objective: To compare treatment practices among pediatric trauma centers and to describe outcomes for available treatment modalities.

Methods: Clinical and radiographic data were collected from a patient cohort with BCVI between 2003 and 2013 at 4 academic pediatric trauma centers.

Results: Among 645 pediatric patients evaluated with computed tomography angiography for BCVI, 57 vascular injuries (82% carotid artery, 18% vertebral artery) were diagnosed in 52 patients. Grade I (58%) and II (23%) injuries accounted for most lesions. Severe intracranial or intra-abdominal hemorrhage precluded antithrombotic therapy in 10 patients. Among the remaining patients, primary therapy was an antiplatelet agent in 14 (33%), anticoagulation in 8 (19%), endovascular intervention in 3 (7%), open surgery in 1 (2%), and no treatment in 16 (38%). Among 27 eligible grade I injuries, 16 (59%) were not treated, and the choice to not treat varied significantly among centers (P < .001). There were no complications from medical management. Glasgow Coma Scale (GCS) score <8 and increasing injury grade were predictors of injury progression (P = .001 and .004, respectively). Poor GCS score (P = .02), increasing injury grade (P = .03), and concomitant intracranial injury (P = .02) correlated with increased risk of mortality. Treatment modality did not correlate with progression of vascular injury or mortality.

Conclusion: Treatment of BCVI with antiplatelet or anticoagulant therapy is safe and may confer modest benefit. Nonmodifiable factors, including presenting GCS score, vascular injury grade, and additional intracranial injury, remain the most important predictors of poor outcome.

Abbreviations: ATT, antithrombotic therapyBCVI, blunt cerebrovascular injuryCTA, computed tomography angiographyGCS, Glasgow Coma Scale.

Download full-text PDF

Source Listing
December 2016
18 Reads

Publication Analysis

Top Keywords

blunt cerebrovascular
pediatric trauma
cerebrovascular injury
treatment practices
58% 23%
injuries accounted
23% injuries
accounted lesions
patients grade
grade 58%
diagnosed patients
lesions severe
hemorrhage precluded
precluded antithrombotic
intra-abdominal hemorrhage
intracranial intra-abdominal
severe intracranial
artery diagnosed
antithrombotic therapy


(Supplied by CrossRef)

Corneille et al.
J Trauma 2011

Biffl et al.
Ann Surg 2002

Miller et al.
J Trauma 2001

Azarakhsh et al.
J Trauma Acute Care Surg 2013

Bromberg et al.
J Trauma 2010

Biffl et al.
J Trauma 1999

Harris et al.
J Biomed Inform 2009

Jones et al.
Am J Surg 2012

Kopelman et al.
J Trauma 2011

Fabian et al.
Ann Surg 1996

Ravindra et al.
J Neurosurg Pediatr 2015

Similar Publications