Incidence of Blunt Cerebrovascular Injury in Pediatric Hangings and Recommendation for Screening
Alena A. Golubkova, Heather Liebe, Tyler Leiva, Kenneth Stewart, Zoona Sarwar, Catherine J. Hunter, *Jeremy J. Johnson
University of Oklahoma Health Sciences Center, Oklahoma City, OK
Background: The incidence of pediatric blunt cerebrovascular injury (BCVI) after strangulation is ill-defined. Current guidelines suggest imaging for screening. Recent reviews have called this into question, reporting that BCVI rarely occurs after hanging, especially if the patient is asymptomatic. We aimed to characterize BCVI incidence in pediatric hanging cases to determine the value of radiographic imaging during the work up.
Methods: We studied 197 pediatric strangulation cases reported to the National Trauma Databank (NTDB) for 2017-2019. Imaging and BCVI diagnosis were reviewed. Findings suggestive of potential BCVI, such as Glasgow Coma Scale (GCS) ≤8, presence of cervical injury, and soft tissue injury, were also considered.
Findings: We found a BCVI incidence of 5% (10 of 197) in this group of children after hanging injury. Only 42% of the patients had a CTA completed. Of the ten BCVI patients, one had a cervical injury (C1/C2 dislocation), eight suffered cervical soft tissue injury, and two reported a diagnosis of brain injury. All ten patients arrived with signs of life, six sedated/paralyzed, and five intubated. Therefore, only two of the ten had reliable GCS scores. No stroke sequelae were reported during hospitalization.
Conclusions: It is suggested that BCVI is uncommon after hanging. In review of pediatric hanging cases reported to NTDB for 2017-2019, we found a 5% incidence. Given only 42% of the patients had a CTA reported, the actual incidence may be higher. When anoxic brain injury is suspected, a patient is likely to receive a CT Head. Based on our findings, we propose that the addition of CTA is also worthwhile. Our study is limited by the completeness of data reported to NTDB. Not all BCVI cases reported cervical imaging. Further studies into BCVI-associated sequelae, treatment patterns and compliance, and symptom onset in the pediatric population are needed.
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