Analyzing computed tomography Modalities for screening pediatric patients for traumatic blunt cerebrovascular injury

• Published in: The American journal of surgery 2024-12, Vol.238, p.115859, Article 115859
• Main Authors: Sainz, Dylan B., Howell, Erin C., Grayeb, Dominique R., Barlas, Yalda, Gonzalez, Deanna, Miskimins, Richard
• Format: Article
• Language: English
• Subjects: Adolescent; All terrain vehicles; Angiography; Blunt cerebrovascular injury (BCVI); Cerebrovascular Trauma - diagnostic imaging; Child; Child, Preschool; Computed tomography; Computed Tomography Angiography; CT angiography; Ethnicity; Female; Fractures; Humans; Infant; Injuries; Injury analysis; Length of stay; Male; Mass Screening - methods; Medical imaging; Morbidity; Mortality; Neck; Patients; Pediatric trauma; Pediatrics; Population; Radiation; Retrospective Studies; Tomography; Tomography, X-Ray Computed - statistics & numerical data; Trauma; Trauma Centers; Universal BCVI screening; Veins & arteries; Wounds, Nonpenetrating - diagnostic imaging
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115859

Optimal screening for BCVI in pediatric trauma patients remains debated. We hypothesized screening with CTAN would decrease the number of duplicate CT scans per patient and increase BCVI detection rate. Local BCVI screening institutional protocol changed May 2022 to include Computed Tomography angiography neck (CTAN). We performed a retrospective review of pediatric blunt trauma patients presenting at our Level 1 trauma center between 2019 and 2023. Patients before and after implementation of universal screening were compared for demographic, clinical, radiographic, and outcome data. Six-hundred-eight patients were included with 368 before and 240 after the protocol change. Screening with CTAN decreased the number of duplicate neck scans (5.7%vs.2.1 ​%,p ​= ​0.03) and increased BCVI detection rate (0.27%v.2.5 ​%,p ​= ​0.01). Of the seven patients diagnosed with BCVI 2019–2023, no patients suffered any stroke-related morbidity. Universal screening for BCVI in pediatric patients with CTAN resulted in fewer scans and an increased BCVI detection rate. •BCVI incidence is increasing due to increased use of radiologic screening•BCVI screening criteria fail to stratify which patients require radiologic imaging•Universal screening with CTA neck decreases total number of CT scans•Universal screening with CTA neck increases BCVI detection rate