Blunt cerebrovascular injury in pediatric trauma: a national database study
Blunt cerebrovascular injury in pediatric trauma: a national database study
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DOI：
10.3171/2019.5.peds18765
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发表时间：
2019-10-01
影响因子：
1.9
通讯作者：
Carlson, Andrew P.
中科院分区：
文献类型：
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作者：
Harris, Dominic A.;Sorte, Danielle E.;Carlson, Andrew P.
目的儿童钝性脑血管损伤（BCVI）的发病率尚未得到很好的描述。本研究的目的是描述儿童脑血管损伤患者的发病率、患者特征和危险因素。方法作者收集了2000年、2003年、2006年、2009年和2012年儿童住院患者数据库（KID）的数据，KID是一个全国代表性的儿科住院数据库。549例因钝性创伤入院，2150例与BCVI相关，总发生率为0.33%。BCVI的发病率几乎翻了一番，从2000年的0.24%增加到2012年的0.49%。年龄在4 - 13岁之间的患者发生BCVI的可能性低于最年轻（0-3岁）和最年长年龄组（包括青少年（14-17岁）和年轻成人（18-20岁））的患者。BCVI与宫颈癌相关，（校正OR [aOR] 4.6，95% CI 3.8 5.5），颅底（aOR 3.0，95%CI 2.5-3.6），锁骨（aOR 1.4，95% CI 1.1-1.8），面部（aOR 1.2，95% CI 1.01.5）骨折，以及颅内出血（aOR 2.7，95% CI 2.2-3.2）和创伤性脑损伤（aOR 2.0，95% CI 1.7-2.3）。损伤机制也与BCVI独立相关：机动车碰撞（aOR 1.7，95% CI 1.3-2.2）和行人被撞（aOR 1.4，95% CI 1.0-1.9）。在小儿BCVI患者中，37.4%的脑缺血性梗死，住院死亡率为12.7%，中风患者的死亡率为20%mortality.CONCLUSIONS小儿BCVI的发病率正在增加，可能是由于增加使用筛选，但仍然低于在成人人群。危险因素包括颈椎、面部、锁骨和颅底骨折，与成人人群相似。诊断的BCVI与相对高的中风发病率相关，发病率和死亡率增加。考虑到本研究中确定的风险因素的相似性，使用成人筛选标准可能是合理的。抗血小板药物或抗凝治疗的作用需要进一步研究。
OBJECTIVE The 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.METHODS The authors collected data from the Kids' Inpatient Database (KID), a nationally representative database of pediatric admissions, for years 2000, 2003, 2006, 2009, and 2012.RESULTS Among 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 1.01.5) 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.CONCLUSIONS The 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.