The Utility of CT Angiography in Predicting Vascular Injury in Pediatric Trauma Patients
Anna Olds, Patricia Berkanish, *Joelle Pierre, *Yi-Horng Lee
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
Background: The indications for cerebrovascular CT Angiography (CTA) in children have been extrapolated from adult trauma experiences, but pediatric patients may not have the same propensity for cerebrovascular injury as adults. Therefore, we seek to determine the utility of cerebrovascular CTA in pediatric trauma populations.
Methods: A retrospective review of trauma patients ages 0-21 from our institution who underwent cerebrovascular CTA from 1/2009-3/2015 was performed. Data points include demographics, injury mechanism, presence or absence of vascular injury, associated injuries, admission GCS scores, admission/discharge neurological deficits, anticoagulation/antiplatelet treatment, and vascular injury interventions.
Results: 114 patients underwent cerebrovascular CTA. All patients had CT of the head/neck prior to CTA, which detects all injuries other than vascular. Seventeen (15%) had vascular injuries. Of these 17 patients, 88% were male, 41% had GCS score ≤8, 71% reported loss of consciousness and had intracranial hemorrhage, 29% had focal admission neurological deficits, and 2 mortalities occurred. Fifteen (88%) sustained blunt trauma and 3 (18%) sustained penetrating trauma. Eleven patients (65%) had skull base and/or maxillofacial fractures. Of the 3 (18%) with cerebral infarcts, all had pseudoaneurysm formations and two had ICA dissection. Four (24%) had global neurological deficits on discharge. Eight patients (47%) required anticoagulation, antiplatelet therapy, operative intervention, or a combination.
Conclusions: Only 15% of patients had vascular injuries detected on CTA, with 88% blunt trauma. Of these 15%, 53% did not require intervention for vascular injury, indicating that CTA may be unnecessary for these 53%. With the low rate of pediatric vascular injuries requiring intervention, we are likely over-utilizing CTA, and increasing radiation exposures.
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