Outcomes And Treatment Of Blunt Cerebrovascular Injury In Children: A Prospective Observational Study
*Ruth Lewit1, *Adam Alder2, *Jeremy Johnson3, Samara Lewis3, *Todd Maxson4, *Jessica Naiditch5, *David Notrica6, Carol Rangel4, Lois Sayrs6, Rachel Stottlemyre6, Sandra Grimes1, *Trey Eubanks1
1Le Bonheur Children's Hospital, University of Tennessee Health Sciences Center, Memphis, TN;2Children's Health, Dallas, TX;3Oklahoma Children's Health, Oklahoma City, OK;4Arkansas Children's Hospital, Little Rock, AR;5Dell Children's Hospital, Austin, TX;6Phoenix Children's Hospital, Phoenix, AZ
Background: The treatment of blunt cerebrovascular injury (BCVI) in children is variable, with a reported stroke rate of 18-37%. Our study sought to prospectively evaluate treatment patterns and outcomes in children with BCVIs.
Methods: This is a prospective, multi-institutional observational study of children <15 years old who sustained blunt trauma to the head, face or neck (AIS>0) and presented to any of six level-one pediatric trauma centers from 2017-2020. Patients were screened using the Memphis Criteria. If a BCVI was diagnosed, heparin vs aspirin was recommended based on overall trauma burden, with 7-10 day follow up imaging.
Findings: 2,285 patients met inclusion criteria and 25 (1.09%) were diagnosed with a BCVI. Six individuals with BCVI suffered a stroke (24%) and mortality was 24% (n=6). BCVI was identified following stroke in 3 patients [Figure]. Five patients had more than one vessel injured. Six (20%) of 25 patients had a vertebral artery injury. Eight underwent treatment: 2 with aspirin alone, 1 with heparin alone, 3 with a combination of aspirin and heparin, 1 with thrombolysis and 1 with endovascular repair. One patient developed a stroke despite treatment, while 2 untreated patients developed a stroke (p=NS). Only 3 who were not treated had contraindications.
Conclusions: Similar to adults, BCVI in children carries a significant risk of stroke. Treatment of BCVI in children is inconsistently applied but may decrease the stroke rate and its associated morbidity and mortality.
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