小儿钝性脑血管损伤：全国创伤数据库研究。
Pediatric blunt cerebrovascular injuries: A national trauma database study.
机构信息
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
Center for Injury Research and Policy at the Research Institute, Nationwide Children's Hospital, Columbus, OH.
出版信息
J Pediatr Surg. 2020 May;55(5):917-920. doi: 10.1016/j.jpedsurg.2020.01.043. Epub 2020 Jan 31.
BACKGROUND
The incidence of blunt cerebrovascular injuries (BCVIs) in children is unknown. We aimed to determine the rate and consequences of BCVIs in pediatric blunt trauma patients.
METHODS
We queried the National Trauma Data Bank (NTDB) for all blunt trauma patients between 2007 and 2014. BCVI patients were identified by ICD-9 codes. Demographic, emergency room, and concomitant injury data were analyzed.
RESULTS
There were 732,702 blunt trauma patients, and 1682 BCVIs were identified (0.23%). 791 (47%) sustained carotid artery injuries (CAIs), 957 (57%) had vertebral artery injuries (VAIs), and 4% of patients sustained both. A majority of the injuries occurred in white patients (61%) and in motor vehicle accidents (53%). The average age was 12.1 ± 5.4 years. CAIs had more skull base fractures (55% vs 35%, p < 0.0001), and cervical spine fractures were more common in VAIs (26 vs 11%, p < 0.0001). Intensive care length of stay was longer in the CAI patients (9.2 vs 7.9 days, p = 0.03), as was length of stay (12.5 vs 9.7 days, p = 0.0002). 5% of CAI patients were coded for stroke, versus 2% of VAIs (p = 0.002).
CONCLUSIONS
BCVIs are rare in children. Vertebral injuries are more common. Carotid injuries are associated with a longer length of stay and higher stroke rates.
TYPE OF STUDY
Retrospective cohort study.
LEVEL OF EVIDENCE
III.
背景
儿童钝性脑血管损伤（BCVI）的发生率尚不清楚。本研究旨在确定儿童钝性创伤患者中 BCVI 的发生率及其后果。
方法
我们检索了 2007 年至 2014 年期间国家创伤数据库（NTDB）中所有的钝性创伤患者。通过 ICD-9 编码识别 BCVI 患者。分析了人口统计学、急诊室和合并伤数据。
结果
共有 732702 例钝性创伤患者，其中 1682 例（0.23%）为 BCVI。791 例（47%）患者发生颈内动脉损伤（CAI），957 例（57%）发生椎动脉损伤（VAI），4%的患者同时发生两种损伤。大多数损伤发生在白人患者（61%）和机动车事故中（53%）。患者的平均年龄为 12.1±5.4 岁。CAI 患者更易发生颅底骨折（55% vs 35%，p<0.0001），VAI 患者更易发生颈椎骨折（26% vs 11%，p<0.0001）。CAI 患者的 ICU 住院时间更长（9.2 天 vs 7.9 天，p=0.03），住院时间也更长（12.5 天 vs 9.7 天，p=0.0002）。5%的 CAI 患者被编码为中风，而 VAI 患者为 2%（p=0.002）。
结论
BCVI 在儿童中罕见。椎动脉损伤更常见。颈动脉损伤与较长的住院时间和更高的中风发生率相关。
研究类型
回顾性队列研究。
证据水平
III 级。
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