Pediatric Blunt Carotid Injury: A Review of the National Pediatric Trauma Registry

Lew, Sean M.; Frumiento, Carmine; Wald, Steven L.

doi:10.1159/000028804

Cited by 80 publications

(47 citation statements)

References 19 publications

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“…15,29 In children, this injury seems to be significantly less common (estimated at 0.03%). 32 However, because CAD can be clinically silent, its frequency may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

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Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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Object Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. Methods A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. Results No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. Conclusions As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.

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“…15,29 In children, this injury seems to be significantly less common (estimated at 0.03%). 32 However, because CAD can be clinically silent, its frequency may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

“…Although relevant to the topic, the article published by Lew et al, 32 who reported on 15 pediatric patients with "blunt carotid injury," was also excluded given the lack of pertinent details regarding each case, which were so important in our analysis.…”

Section: Literature Reviewmentioning

confidence: 99%

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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“…4,21 Previous studies have suggested that BCVI complicates 0.03%-0.9% of traumatic brain injuries (TBIs) in children 1,12,14,17 and that the risk factors in this population may be similar to those seen in adults; 14 however, recent evidence indicates that patterns of intracranial injury observed on head CT scans in children are significantly different from the patterns observed in adults. 24 This relatively low incidence has led to the speculation that children with TBI are inadequately screened, 1 potentially increasing the number of children who undergo CTA.…”

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confidence: 99%

Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

Ravindra

Riva-Cambrin

Sivakumar

et al. 2015

PED

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OBJECT Computed tomography angiography (CTA) is frequently used to examine patients for blunt cerebrovascular injury (BCVI) after cranial trauma, but the pediatric population at risk for BCVI is poorly defined. Although CTA is effective for BCVI screening in adults, the increased lifetime risk for malignant tumors associated with this screening modality warrants efforts to reduce its use in children. The authors' objective was to evaluate the incidence of BCVI diagnosed by CTA in a pediatric patient cohort and to create a prediction model to identify children at high risk for BCVI. METHODS Demographic, clinical, and radiographic data were collected retrospectively for pediatric patients who underwent CTA during examination for traumatic cranial injury from 2003 through 2013. The primary outcome was injury to the carotid or vertebral artery diagnosed by CTA. RESULTS The authors identified 234 patients (mean age 8.3 years, range 0.04–17 years, 150 [64%] boys) who underwent CTA screening for BCVI. Of these, 24 (10.3%) had a focal neurological deficit, and 153 (65.4%) had intracranial hemorrhage on a head CTA. Thirty-seven BCVIs were observed in 36 patients (15.4%), and 16 patients (6.8%) died. Multivariate regression analysis identified fracture through the carotid canal, petrous temporal bone fracture, Glasgow Coma Scale (GCS) score of < 8, focal neurological deficit, and stroke on initial CT scan as independent risk factors for BCVI. A prediction model for identifying children at high risk for BCVI was created. A score of ≤ 2 yielded a 7.9% probability of BCVI and a score of ≥ 3 a risk of 39.3% for BCVI. CONCLUSIONS For cranial trauma in children, fracture of the petrous temporal bone or through the carotid canal, focal neurological deficit, stroke, and a GCS score of < 8 are independent risk factors for BCVI.

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“…A review of the U.S. National Pediatric Trauma Registry found only 15 cases (0.03%) of ICA occlusion caused by blunt injury among 57,659 patients with blunt trauma aged less than 19 years old. 5) Traumatic ICA occlusion caused by blunt injury is extremely rare in infants aged less than 12 months. The only previously reported case occurred in an 11-month-old girl who fell to the floor.…”

Section: Discussionmentioning

confidence: 99%

“…Investigation for traumatic ICA occlusion is of vital importance, even if there is no wound in the neck. 1,5,7) Ultrasonography is most useful for detecting traumatic ICA occlusion before it becomes symptomatic in an infant.…”

Section: ) Radiologicalmentioning

confidence: 99%

Traumatic Cervical Internal Carotid Artery Occlusion in an Infant-Case Report-

Igarashi

Mori²,

Moro³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 10-month-old boy presented with traumatic internal carotid artery (ICA) occlusion caused by blunt injury after falling from a baby carrier attached to a standing bicycle. Physical examination found bruises on the scalp in the right temporal region and the right shoulder, but no wound in the neck. Chest radiography showed a right clavicular fracture. He developed left hemiparesis at 19 hours after the injury. Computed tomography revealed cerebral infarct and angiography showed cervical ICA occlusion. Conservative therapy with hemodilution was given under a diagnosis of cervical ICA occlusion caused by extension and rotational head injury. Traumatic cervical ICA occlusion due to blunt injury is not uncommon in adults, but extremely rare in infants. We would like to emphasize the dangers of leaving a baby unattended in a carrier attached to a standing bicycle.

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Pediatric Blunt Carotid Injury: A Review of the National Pediatric Trauma Registry

Cited by 80 publications

References 19 publications

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study

Traumatic Cervical Internal Carotid Artery Occlusion in an Infant-Case Report-

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