Implementation of a dual cervical spine and blunt cerebrovascular injury assessment pathway for pediatric trauma patients

Blunt cerebrovascular injury (BCVI) is a term encompassing traumatic carotid and vertebral artery dissection or disruption. While the reported incidence appears to be increasing as diagnostic modalities improve, these injuries are often diagnosed only after patients have developed acute neurologic symptoms. These injuries often result in severe permanent neurologic disability or death. The gold standard for diagnosis has historically been a 4-vessel arteriogram. However, newer data are suggesting that computed tomographic angiography may be more appropriate for most patients and new criteria for its utilization have been developed. We report a case of bilateral carotid dissection in a 23-year-old woman involved in a motor vehicle collision (MVC). She initially presents with a normal neurologic exam and two hours later develops hemiparesis. She is treated with antiplatelet therapy and given intravascular catheter directed tissue plasminogen activator with carotid stent placement. Nonetheless, the patient goes on to require intubation and, ultimately, a tracheostomy and transfer to an inpatient rehabilitation setting due to continued hemiparesis. This case highlights the need for increased awareness of a potentially debilitating, life-threatening disease process. A high index of suspicion is required among emergency medicine physicians for early diagnosis and treatment of trauma patients with BCVI.

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Analysis of blunt cerebrovascular injury in pediatric trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002511 ◽

2019 ◽

Vol 87 (6) ◽

pp. 1354-1359

Author(s):

Areg Grigorian ◽

Matthew Dolich ◽

Michael Lekawa ◽

Roy M. Fujitani ◽

Nii-Kabu Kabutey ◽

...

Keyword(s):

Pediatric Trauma ◽

Blunt Cerebrovascular Injury ◽

Cerebrovascular Injury

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Diagnostic Accuracy of Computed Tomographic Angiography for Blunt Cerebrovascular Injury Detection in Trauma Patients

Annals of Surgery ◽

10.1097/sla.0b013e318288c514 ◽

2013 ◽

Vol 257 (4) ◽

pp. 621-632 ◽

Cited By ~ 62

Author(s):

Derek J. Roberts ◽

Vikas P. Chaubey ◽

David A. Zygun ◽

Diane Lorenzetti ◽

Peter D. Faris ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Computed Tomographic Angiography ◽

Trauma Patients ◽

Blunt Cerebrovascular Injury ◽

Computed Tomographic ◽

Cerebrovascular Injury ◽

Tomographic Angiography

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Cervical spine computed tomography utilization in pediatric trauma patients

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2013.10.006 ◽

2014 ◽

Vol 49 (2) ◽

pp. 333-337 ◽

Cited By ~ 18

Author(s):

Kathleen M. Adelgais ◽

Lorin Browne ◽

Maija Holsti ◽

Ryan R. Metzger ◽

Shannon Cox Murphy ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Pediatric Trauma ◽

Trauma Patients

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Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury

Surgery ◽

10.1016/j.surg.2006.04.005 ◽

2007 ◽

Vol 141 (1) ◽

pp. 76-82 ◽

Cited By ~ 86

Author(s):

C. Clay Cothren ◽

Ernest E. Moore ◽

Charles E. Ray ◽

Jeffrey L. Johnson ◽

John B. Moore ◽

...

Keyword(s):

Cervical Spine ◽

Spine Fracture ◽

Cervical Spine Fracture ◽

Blunt Cerebrovascular Injury ◽

Cerebrovascular Injury ◽

Fracture Patterns ◽

Rule Out

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Factors Associated With the Use of Cervical Spine Computed Tomography Imaging in Pediatric Trauma Patients

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2011.01154.x ◽

2011 ◽

Vol 18 (9) ◽

pp. 905-911 ◽

Cited By ~ 18

Author(s):

Rebekah Mannix ◽

Lise E. Nigrovic ◽

Sara A. Schutzman ◽

Kara Hennelly ◽

Florence T. Bourgeois ◽

...

Keyword(s):

Computed Tomography ◽

Cervical Spine ◽

Pediatric Trauma ◽

Trauma Patients ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Factors Associated

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Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study

Pediatric Neurosurgery ◽

10.1159/000028789 ◽

1999 ◽

Vol 30 (4) ◽

pp. 169-175 ◽

Cited By ~ 37

Author(s):

Alan M. Scarrow ◽

Elad I. Levy ◽

Daniel K. Resnick ◽

P. David Adelson ◽

Robert J. Sclabassi

Keyword(s):

Cervical Spine ◽

Pilot Study ◽

Pediatric Trauma ◽

Trauma Patients

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Existence of knowledge silos in the adult blunt cerebrovascular injury literature

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000741 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000741

Author(s):

Zane Schnurman ◽

Gustavo Chagoya ◽

Jan O Jansen ◽

Mark R Harrigan

Keyword(s):

Network Analysis ◽

Trauma Surgery ◽

Active Role ◽

Digital Object Identifier ◽

Trauma Patients ◽

Level Of Evidence ◽

Blunt Cerebrovascular Injury ◽

Cerebrovascular Injury ◽

Peer Reviewers ◽

Python Programming

BackgroundBlunt cerebrovascular injuries (BCVI) remain a significant source of disability and mortality among trauma patients. The purpose of the present study was to determine whether knowledge silos exist in the overall BCVI literature.MethodsAn object-oriented programmatic script written in Python programming language was used to extract and categorize articles and references on the topic of BCVI. Additionally, each BCVI article was searched for by digital object identifier in the other BCVI references to build a network analysis and visualize topic reference patterns. Analyses were performed using Stata V.14.2 (StataCorp).ResultsA total of 306 articles with 10 282 references were included for analysis. Of these, 24% (74) were published in neurosurgery journals, 45% (137) were published in trauma journals, and 31% (95) were published in a journal of another specialty. Similar proportions were found when categorized by author departmental affiliation. Trauma surgery authors disproportionately referenced articles in the trauma literature, compared with neurosurgeons (73.5% vs. 48.0%, p<0.0001), and other authors. The biggest factor influencing reference proportions was the specialty of the publishing journal. Finally, a network analysis revealed that there are more trauma BCVI articles, and there are more frequently cited trauma BCVI articles by all specialties.ConclusionsThis study revealed the existence of a one-way knowledge silo in the BCVI literature. However, a robust preference by both trauma and neurosurgery to cite trauma references when publishing in trauma journals may indicate a possible conscious curating of citations by authors to increase the likelihood of publication. These observations highlight the need for an active role by journal editors, peer reviewers, and authors to actively foster diversity of citations and cross-specialty collaboration to improve dissemination of information between these specialties.Level of evidenceLevel IV. Observational study.

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