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

2015 ◽  
Vol 15 (6) ◽  
pp. 599-606 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Jay Riva-Cambrin ◽  
Walavan Sivakumar ◽  
Ryan R. Metzger ◽  
Robert J. Bollo
Keyword(s):  
Risk Factors ◽  
Neurological Deficit ◽  
Pediatric Population ◽  
Blunt Cerebrovascular Injury ◽  
Focal Neurological Deficit ◽  
Cerebrovascular Injury ◽  
Cranial Trauma ◽  
Carotid Canal ◽  
Independent Risk Factors ◽  
Gcs Score

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.

Blunt cerebrovascular injury in pediatric trauma: a national database study

2019 ◽  
Vol 24 (4) ◽  
pp. 451-460 ◽  
Author(s):  
Dominic A. Harris ◽  
Danielle E. Sorte ◽  
Sandi K. Lam ◽  
Andrew P. Carlson
Keyword(s):  
Risk Factors ◽  
Skull Base ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Pediatric Population ◽  
Adult Population ◽  
Pediatric Trauma ◽  
National Database ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury

OBJECTIVEThe incidence of blunt cerebrovascular injury (BCVI) has not been well characterized in the pediatric population. The goal of this study was to describe the incidence, patient characteristics, and risk factors for pediatric patients with cerebrovascular injuries.METHODSThe authors collected data from the Kids’ Inpatient Database (KID), a nationally representative database of pediatric admissions, for years 2000, 2003, 2006, 2009, and 2012.RESULTSAmong an estimated 646,549 admissions for blunt trauma, 2150 were associated with BCVI, an overall incidence of 0.33%. The incidence of BCVI nearly doubled from 0.24% in 2000 to 0.49% in 2012. Patients 4 to 13 years of age were less likely to have BCVI than those in the youngest (0–3 years) and oldest age groups comprising adolescents (14–17 years) and young adults (18–20 years). BCVIs were associated with cervical (adjusted OR [aOR] 4.6, 95% CI 3.8–5.5), skull base (aOR 3.0, 95% CI 2.5–3.6), clavicular (aOR 1.4, 95% CI 1.1–1.8), and facial (aOR 1.2, 95% CI 1.0–1.5) fractures, as well as intracranial hemorrhage (aOR 2.7, 95% CI 2.2–3.2) and traumatic brain injury (aOR 2.0, 95% CI 1.7–2.3). Mechanism of injury was also independently associated with BCVI: motor vehicle collision (aOR 1.7, 95% CI 1.3–2.2) and struck pedestrian (aOR 1.4, 95% CI 1.0–1.9). Among pediatric patients with BCVI, 37.4% had cerebral ischemic infarction with an in-hospital mortality of 12.7%, and patients with stroke had 20% mortality.CONCLUSIONSThe incidence of pediatric BCVI is increasing, likely due to increased use of screening, but remains lower than that in the adult population. Risk factors include the presence of cervical, facial, clavicular, and skull base fractures, similar to that of the adult population. Diagnosed BCVI is associated with a relatively high incidence of stroke with increased morbidity and mortality. The use of adult screening criteria is likely reasonable given the similarity in the risk factors identified in this study. Further studies are needed to investigate the role of treatment with antiplatelet agents or anticoagulation.

scholarly journals Stroke prediction in patients presenting with isolated dizziness in the emergency department

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
June-sung Kim ◽  
Hong Jun Bae ◽  
Muyeol Kim ◽  
Shin Ahn ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Multivariate Analysis ◽  
Acute Stroke ◽  
Neurological Deficits ◽  
Cerebrovascular Injury ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Record Review

AbstractDiagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. The aim of this study was to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

scholarly journals Stroke prediction in patients presenting with isolated dizziness in the emergency department

2020 ◽  
Author(s):  
June-sung Kim ◽  
Hong Jun Bae ◽  
Muyeol Kim ◽  
Shin Ahn ◽  
Chang Hwan Sohn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Multivariate Analysis ◽  
Acute Stroke ◽  
Neurological Deficits ◽  
Cerebrovascular Injury ◽  
Risk Patients ◽  
History Of ◽  
Independent Risk Factors ◽  
Record Review

Abstract Diagnosing stroke in patients experiencing dizziness without neurological deficits is challenging for physicians. This study tried to evaluate the prevalence of acute stroke in patients who presented with isolated dizziness without neurological deficits at the emergency department (ED), and determine the relevant stroke predictors in this population. This was an observational, retrospective record review of consecutive 2,215 adult patients presenting with dizziness at the ED between August 2019 and February 2020. Multivariate analysis was performed to identify risk factors for acute stroke. 1,239 patients were enrolled and analyzed. Acute stroke was identified in 55 of 1,239 patients (4.5%); most cases (96.3%) presented as ischemic stroke with frequent involvement (29.1%) of the cerebellum. In the multivariate analysis, the history of cerebrovascular injury (odds ratio [OR] 3.08 [95% confidence interval {CI} 1.24 to 7.67]) and an age of > 65 years (OR 3.01 [95% CI 1.33 to 6.83]) were the independent risk factors for predicting acute stroke. The combination of these two risks showed a higher specificity (94.26%) than that of each factor alone. High-risk patients, such as those aged over 65 years or with a history of cerebrovascular injury, may require further neuroimaging workup in the ED to rule out stroke.

Angiographic frequency of blunt cerebrovascular injury in patients with carotid canal or vertebral foramen fractures on multidetector CT

2007 ◽  
Vol 62 (3) ◽  
pp. 385-393 ◽  
Author(s):  
Alexander McKinney ◽  
Frederick Ott ◽  
James Short ◽  
Zeke McKinney ◽  
Charles Truwit
Keyword(s):  
Multidetector Ct ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Carotid Canal

Risk Factors for Blunt Cerebrovascular Injury in Children: Do They Mimic Those Seen in Adults?

2011 ◽  
Vol 71 (3) ◽  
pp. 559-564 ◽  
Author(s):  
Tammy R. Kopelman ◽  
Nicole E. Berardoni ◽  
Patrick J. OʼNeill ◽  
Poya Hedayati ◽  
Sydney J. Vail ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury

scholarly journals Risk factors of recurrent acute pancreatitis after conservative treatment in pediatric population: a single-center study

2021 ◽  
Vol 4 (1) ◽  
pp. e000209
Author(s):  
Qipeng Zheng ◽  
Xueqiang Yan ◽  
Liang Ge ◽  
Shujian Zhang ◽  
Yan Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Pancreatitis ◽  
Diagnostic Criteria ◽  
Pediatric Population ◽  
Treatment Strategies ◽  
First Episode ◽  
Initial Attack ◽  
Recurrent Acute Pancreatitis ◽  
Fasting Time ◽  
Independent Risk Factors

BackgroundAlthough complete resolution and recovery occurs in most children with an initial attack of acute pancreatitis (AP), a subset of children may progress to recurrent AP (RAP). RAP has serious effects to the individual and the socioeconomic burden. The aim of this project was to identify the independent risk factors for pediatric RAP so as to provide evidence for its prevention, early diagnosis and treatment.MethodsA retrospective cohort study of children discharged from Tianjin Children’s Hospital from June 2017 to January 2020 was performed. Demographic and clinical variables, treatment strategies, clinical course and outcomes were collected. Independent risk factors of RAP were identified using the logistic regression model.ResultsOf the total 96 enrolled children, 30 (31.3%) developed RAP during the follow-up period. The majority (27/30, 90%) of the children with AP developed RAP within 6 months of their first AP attack. The presence of systemic inflammatory response syndrome (SIRS) [odds ratio (OR)=6.652, 95% confidence interval (CI) 1.989 to 22.247], fasting time (OR=1.267, 95% CI 1.104 to 1.583), whether meet all three AP diagnostic criteria (OR=7.438, 95% CI 1.346 to 41.103) and abnormal amylase/lipase value on the seventh day of hospitalization (OR=3.601, 95% CI 0.972 to 13.342) were independent risk factors of RAP in children.ConclusionsMost children who developed RAP had progressed within 6 months after their first episode of AP. RAP was more common in children who met all three AP diagnostic criteria at initial attack and in children with SIRS, long fasting time and abnormal amylase/lipase value on the seventh day of hospitalization.

Statistical learning of blunt cerebrovascular injury risk factors using the elastic net

2021 ◽  
Author(s):  
Maxwell E. Cooper ◽  
Benjamin Risk ◽  
Amanda Corey ◽  
Arthur J. Fountain ◽  
Jason W. Allen
Keyword(s):  
Risk Factors ◽  
Statistical Learning ◽  
Injury Risk ◽  
Elastic Net ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Injury Risk Factors

Thirty-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy

2013 ◽  
Vol 118 (6) ◽  
pp. 1329-1335 ◽  
Author(s):  
Yu-Hua Huang ◽  
Tao-Chen Lee ◽  
Tsung-Han Lee ◽  
Chen-Chieh Liao ◽  
Jason Sheehan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Decompressive Craniectomy ◽  
Multivariate Logistic Regression ◽  
Short Term ◽  
Brain Injured ◽  
Independent Risk Factors ◽  
Traumatically Brain Injured ◽  
Gcs Score ◽  
Injured Patients

Object Decompressive craniectomy is a life-saving measure for patients who have sustained traumatic brain injury (TBI), but patients undergoing this procedure may still die during an early phase of head injury. The aim of this study was to investigate the incidence, causes, and risk factors of 30-day mortality in traumatically brain-injured patients undergoing decompressive craniectomy. Methods The authors included 201 head-injured patients undergoing decompressive craniectomy in this 3-year retrospective study. The main outcome evaluated was 30-day mortality in patients who had undergone craniectomy after TBI. Demographic and clinical data, including information on death, were obtained for subsequent analysis. The authors identified differences between survivors and nonsurvivors in terms of clinical parameters; multivariate logistic regression was used to adjust for independent risk factors of short-term death. Results The 30-day mortality rate was 26.4% in traumatically brain-injured patients undergoing decompressive craniectomy. The majority of deaths following decompression resulted from uncontrollable brain swelling and extensive brain infarction, which accounted for 79.2% of mortality. In the multivariate logistic regression mode, the 2 independent risk factors for 30-day mortality were age (OR 1.035 [95% CI 1.006–1.064]; p = 0.018) and Glasgow Coma Scale (GCS) score before decompressive craniectomy (OR 0.769 [95% CI 0.597–0.990]; p = 0.041). Conclusions There is a high 30-day mortality rate in traumatically brain-injured patients undergoing decompressive craniectomy. Most of the deaths are attributed to ongoing brain damage, even after decompression. Risk factors of short-term death, including age and preoperative GCS score, are important in patient selection for decompressive craniectomy, and these factors should be considered together to ensure the highest chance of surviving TBI.

Sign in / Sign up

Export Citation Format

Share Document