Kline-Fath Beth M, Seman Jessica M, Zhang Bin, Care Marguerite M
Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Radiol. 2021 Sep;51(10):1889-1894. doi: 10.1007/s00247-021-05056-1. Epub 2021 Mar 30.
Acute screening of pediatric strangulation and hanging injuries has evolved at many institutions to include cervical arterial vascular imaging. As current standards in pediatric imaging support less radiation exposure and increased imaging appropriateness, it is questionable whether vascular arterial injury is a true risk in this population.
To determine the role of cervical vascular arterial imaging in the evaluation of pediatric hanging and strangulation injuries.
This is a retrospective study of patients who present at a Level 1 pediatric trauma center with a history of hanging and strangulation injuries. All relevant studies, including computed tomography (CT) angiography of the neck, contrast-enhanced neck CT, cervical magnetic resonance (MR) angiography, magnetic resonance imaging (MRI) and/or CT of the brain and cervical spine and associated clinical records, were reviewed.
Sixty-six patients were identified, 60 with vascular arterial imaging studies. No vascular injury was identified. Soft-tissue injury was noted in 20/66 (30%) patients and craniocervical injury was suspected in 2/66 (3%), but no cervical spine fracture was identified. Only 49 patients had brain imaging, with 7/49 (14%) demonstrating changes consistent with cerebral edema, which correlated negatively with survival (P<0.01).
Vascular arterial imaging, particularly with CT angiography, performed in the pediatric population after hanging and strangulation injury resulted in no positive studies for cervical arterial injury. This study supports the need to reevaluate routine screening CT angiography in this study population.
许多机构对小儿绞勒伤和缢伤的急性筛查已发展为包括颈部动脉血管成像。由于目前小儿成像的标准支持减少辐射暴露并提高成像的适宜性，因此血管损伤在该人群中是否为真正风险值得怀疑。
确定颈部血管成像在小儿缢伤和绞勒伤评估中的作用。
这是一项对在一级小儿创伤中心就诊且有缢伤和绞勒伤病史患者的回顾性研究。回顾了所有相关检查，包括颈部计算机断层扫描（CT）血管造影、颈部增强CT、颈部磁共振（MR）血管造影、磁共振成像（MRI）和/或脑部及颈椎的CT以及相关临床记录。
共确定66例患者，其中60例进行了血管成像检查。未发现血管损伤。20/66（30%）的患者有软组织损伤，2/66（3%）怀疑有颅颈损伤，但未发现颈椎骨折。仅49例患者进行了脑部成像，其中7/49（14%）显示有与脑水肿相符的改变，这与生存率呈负相关（P<0.01）。
小儿缢伤和绞勒伤后进行的血管成像，尤其是CT血管造影，未发现颈部动脉损伤的阳性结果。本研究支持对该研究人群中常规筛查CT血管造影进行重新评估的必要性。
