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.

Traumatic brain injury in pediatric patients: evidence for the effectiveness of decompressive surgery

2011 ◽  
Vol 31 (5) ◽  
pp. E5 ◽  
Author(s):  
Geoffrey Appelboom ◽  
Stephen D. Zoller ◽  
Matthew A. Piazza ◽  
Caroline Szpalski ◽  
Samuel S. Bruce ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Pediatric Trauma ◽  
Anatomical Variations ◽  
Decompressive Surgery ◽  
Pediatric Populations ◽  
The Impact

Traumatic brain injury (TBI) is the current leading cause of death in children over 1 year of age. Adequate management and care of pediatric patients is critical to ensure the best functional outcome in this population. In their controversial trial, Cooper et al. concluded that decompressive craniectomy following TBI did not improve clinical outcome of the analyzed adult population. While the study did not target pediatric populations, the results do raise important and timely clinical questions regarding the effectiveness of decompressive surgery in pediatric patients. There is still a paucity of evidence regarding the effectiveness of this therapy in a pediatric population, and there is an especially noticeable knowledge gap surrounding age-stratified interventions in pediatric trauma. The purposes of this review are to first explore the anatomical variations between pediatric and adult populations in the setting of TBI. Second, the authors assess how these differences between adult and pediatric populations could translate into differences in the impact of decompressive surgery following TBI.

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.

scholarly journals Blunt cerebrovascular injury in the geriatric population

2020 ◽  
Vol 49 (4) ◽  
pp. E10
Author(s):  
Diana T. Le ◽  
Kinsey A. Barhorst ◽  
James Castiglione ◽  
George L. Yang ◽  
Sanjit J. Shah ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Adult Population ◽  
The Elderly ◽  
Morbidity And Mortality ◽  
Categorical Variables ◽  
Clinical Implications ◽  
Blunt Cerebrovascular Injury ◽  
Geriatric Population ◽  
Discharge Disposition ◽  
Cerebrovascular Injury

OBJECTIVEBlunt cerebrovascular injury (BCVI) is associated with high rates of neurological morbidity and mortality. The detection and management of BCVI has improved with advances in imaging and sensitive screening protocols. Few studies have explored how these injuries specifically affect the geriatric population. The purpose of this retrospective analysis was to investigate the presentation and prognosis of BCVI in the elderly population and to assess its clinical implications in the management of these patients.METHODSAll patients presenting to the University of Cincinnati (UC) level I trauma center between February 2017 and December 2019 were screened for BCVI and entered into the prospectively maintained UC Neurotrauma Registry. Patients with BCVI confirmed by CT angiography underwent retrospective chart reviews to collect information regarding demographics, positive screening criteria, cause of injury, antithrombotic agent, injury location, Denver Grading Scale, hospital and ICU length of stay, and discharge disposition. Patients were divided into geriatric (age ≥ 65 years) and adult (age < 65 years) subgroups. Continuous variables were analyzed using the Student t-test and categorical variables with the Pearson chi-square test.RESULTSOf 124 patients with BCVI, stratification by age yielded 23 geriatric and 101 adult patients. Injury in the geriatric group was associated with significantly higher mortality (p = 0.0194). The most common cause of injury in the elderly was falls (74%, 17/23; p < 0.0001), whereas motor vehicle accidents were most common in the adult group (38%, 38/100; p = 0.0642). With respect to the location of injury, carotid (p = 0.1171) and vertebral artery (p = 0.6981) injuries did not differ significantly for the geriatric group. The adult population presented more often with Denver grade I injuries (p < 0.0001), whereas the geriatric population presented with grade IV injuries (p = 0.0247). Elderly patients were more likely to be discharged to skilled nursing facilities (p = 0.0403) and adults to home or self-care (p = 0.0148).CONCLUSIONSThis study is the first to characterize BCVI to all cervical and intracranial vessels in the geriatric population. Older age at presentation is significantly associated with greater severity, morbidity, and mortality from injury, with no preference for the particular artery injured. These findings carry important clinical implications for adapting practice in an aging population.

scholarly journals MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rafael Peñalver Penedo ◽  
Marta Rupérez Lucas ◽  
Luis Antonio Álvarez-Sala Walther ◽  
Alicia Torregrosa Benavent ◽  
María Luisa Casas Losada ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Roc Curves ◽  
Renal Scintigraphy ◽  
Reactive Protein ◽  
Sensitivity Specificity

Abstract Background Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. Methods A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. Results 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. Conclusion MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

scholarly journals Epidemiological and Clinical-Pathological Aspects of Helicobacter pylori Infection in Brazilian Children and Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Evelyn Pedroso Toscano ◽  
Fernanda Fernandes Madeira ◽  
Mayra Pinheiro Dutra-Rulli ◽  
Luiz Otavio Maia Gonçalves ◽  
Marcela Alcântara Proença ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Population ◽  
Adult Population ◽  
Developed Countries ◽  
Upper Gastrointestinal Endoscopy ◽  
Only Children ◽  
Screening Programs ◽  
Adolescents And Adults ◽  
H Pylori ◽  
Over 40 Years

Aim. To evaluate the prevalence and risk factors of H. pylori infection in the pediatric and adult population seen at a public hospital in São José do Rio Preto, SP, Brazil. Methods. This is a retrospective study that evaluated 2406 medical records of children, adolescents, and adults with dyspeptic symptoms who underwent upper gastrointestinal endoscopy. H. pylori diagnosis and demographic and clinical-pathological features were recorded. Results. A total of 852 subjects were H. pylori positive, with an overall prevalence of infection of 35.4%, occurring mainly in adults over 40 years of age, and a 24.7% prevalence considering only children and adolescents. No association was observed between H. pylori infection and risk factors. However, the H. pylori positive individuals showed a higher frequency of pangastritis (p<0.01), severe lesions (p=<0.001), and erosive lesions (p=0.04). The bacterium was eradicated in 83.5% (127) of the patients who received the standard therapy. Conclusions. The prevalence of H. pylori detected in a public service in São José do Rio Preto, SP, Brazil, is as expected for developed countries, showing growing rates with increasing age. As H. pylori infection occurs during childhood, screening programs for detection and prevention in the pediatric population are important to reduce the prevalence of this infection in adults.

scholarly journals NURS-10. IMPROVEMENTS IN A BEHAVIORAL TRAINING AND PHARMACOLOGICAL ANXIOLYSIS ALGORITHM FOR INCREASED COMPLIANCE IN PEDIATRIC PATIENTS IN PREPARATION FOR RADIATION THERAPY: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii422-iii423
Author(s):  
Judy Tran ◽  
Jennifer Holt ◽  
Danielle Crump ◽  
Anita Shea ◽  
Lin Whetzel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Radiation Risk ◽  
Proton Radiation ◽  
Behavioral Training ◽  
Duration Of Treatment ◽  
Behavioral Compliance ◽  
Patients At Risk

Abstract BACKGROUND In the pediatric population, the probability of compliance with radiation involves multifactorial elements. Younger pediatric patients often require anesthesia to ensure accurate delivery of radiotherapy. The purpose of this analysis was to refine our algorithm in pediatric patients to better identify children who would benefit from behavioral training and/or anxiolyxis intervention with the goal of minimizing anesthesia use. METHOD Retrospective data was collected from electronic medical records from 150 pediatric oncology patients &lt;18 years old, treated with photon and proton radiation at our center from August 2016 to December 2019. We identified potential socio-developmental treatment factors thought to impact behavioral compliance and categorized risk factors based on an algorithm to determine risk for noncompliance with radiotherapy. RESULTS Six categories demonstrated statistical significance (p&lt;0.05) in their influence on behavioral compliance during radiotherapy: age category (specifically age &lt;7: Odds ratio [OR] 3.0, 95% Confidence Interval [CI] 1.0, 9.1), need for sedation with prior imaging studies (p&lt;0.001), parental premonition of requiring anesthesia for successful treatment (p&lt;0.001), duration of treatment, primary language (p&lt;0.001), and use of total body irradiation (OR 3.1, 95% CI 1.1, 9.3). CONCLUSION Identification of pre-radiation risk factors allowed for better recognition of patients at risk for treatment non-compliance and for requiring daily sedation. Future studies should focus on implementing the algorithm prospectively in an effort to identify and direct early intervention with behavioral training and/or anxiolytics to minimize the need for sedation.

scholarly journals Deconstructing Dissections: A Case Report and Review of Blunt Cerebrovascular Injury of the Neck

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Brittany A. Walsh ◽  
W. Douglas Gregorie ◽  
Jessica S. Whittle
Keyword(s):  
Motor Vehicle ◽  
Vertebral Artery Dissection ◽  
Disease Process ◽  
Inpatient Rehabilitation ◽  
Computed Tomographic Angiography ◽  
Artery Dissection ◽  
Trauma Patients ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Bilateral Carotid

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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