用于儿科钝性脑血管损伤的筛查工具的诊断准确性：ATOMAC 多中心研究。
Diagnostic accuracy of screening tools for pediatric blunt cerebrovascular injury: An ATOMAC multicenter study.
机构信息
From the Phoenix Children's Center for Trauma Care, Phoenix Children's (T.A.N., D.M.N., M.T., B.P.), Phoenix, Arizona; Department of Pediatric Surgery, Le Bonheur Children's Hospital (R.A.L., J.W.E.) Memphis, Tennessee; Division of Pediatric Surgery, Department of Surgery (R.A.L., J.W.E.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (D.M.N., B.P.), College of Medicine, University of Arizona Phoenix, Arizona; Trauma Services, Children's Medical Center (M.R.), Dallas, Texas; Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center Dallas, Texas; Trauma Services, Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center Oklahoma City, Oklahoma; Trauma Services, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences Little Rock, Arkansas; Department of Surgery, Dell Medical School (J.A.N., K.A.L.), University of Texas at Austin Austin, Texas; and Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):327-333. doi: 10.1097/TA.0000000000003888. Epub 2023 Jan 25.
BACKGROUND
Blunt cerebrovascular injury (BCVI) is rare but significant among children. There are three sets of BCVI screening criteria validated for adults (Denver, Memphis, and Eastern Association for the Surgery of Trauma criteria) and two that have been validated for use in pediatrics (Utah score and McGovern score), all of which were developed using retrospective, single-center data sets. The purpose of this study was to determine the diagnostic accuracy of each set of screening criteria in children using a prospective, multicenter pediatric data set.
METHODS
A prospective, multi-institutional observational study of children younger than 15 years who sustained blunt trauma to the head, face, or neck and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. All patients were screened for BCVI using the Memphis criteria, but criteria for all five were collected for analysis. Patients underwent computed tomography angiography of the head or neck if the Memphis criteria were met at presentation or neurological abnormalities were detected at 2-week follow-up.
RESULTS
A total of 2,284 patients at the 6 trauma centers met the inclusion criteria. After excluding cases with incomplete data, 1,461 cases had computed tomography angiography and/or 2-week clinical follow-up and were analyzed, including 24 cases (1.6%) with BCVI. Sensitivity, specificity, positive predictive value, and negative predictive value for each set of criteria were respectively 75.0, 87.5, 9.1, and 99.5 for Denver; 91.7, 71.1, 5.0, and 99.8 for Memphis; 79.2, 82.7, 7.1, and 99.6 for Eastern Association for the Surgery of Trauma; 45.8, 95.8, 15.5, and 99.1 for Utah; and 75.0, 89.5, 10.7, and 99.5 for McGovern.
CONCLUSION
In this large multicenter pediatric cohort, the Memphis criteria demonstrated the highest sensitivity at 91.7% and would have missed the fewest BCVI, while the Utah score had the highest specificity at 95.8% but would have missed more than half of the injuries. Development of a tool, which narrows the Memphis criteria while maintaining its sensitivity, is needed for application in pediatric patients.
LEVEL OF EVIDENCE
Diagnostic Test/Criteria; Level II.
背景
钝性脑血管损伤（BCVI）在儿童中虽少见但后果严重。目前已有三套用于成人的 BCVI 筛查标准（丹佛、孟菲斯和东部创伤外科学会标准）和两套用于儿科的标准（犹他评分和 McGovern 评分）得到验证，这些标准均基于回顾性、单中心数据集制定。本研究旨在使用前瞻性、多中心儿科数据集确定这些筛查标准在儿童中的诊断准确性。
方法
本研究为前瞻性、多机构观察性研究，纳入 2017 年至 2020 年期间在 6 个一级儿科创伤中心就诊的年龄＜15 岁、因头、面或颈部钝性创伤而就诊的儿童。所有患者均采用孟菲斯标准筛查 BCVI，但也收集了所有 5 项标准的信息进行分析。如果患者就诊时符合孟菲斯标准或在 2 周随访时出现神经功能异常，则进行头颈部 CT 血管造影。
结果
在 6 家创伤中心，共有 2284 例患者符合纳入标准。排除数据不完整的病例后，共有 1461 例患者接受了 CT 血管造影和/或 2 周临床随访，并进行了分析，其中 24 例（1.6%）存在 BCVI。每项标准的敏感性、特异性、阳性预测值和阴性预测值分别为：丹佛标准为 75.0%、87.5%、9.1%和 99.5%；孟菲斯标准为 91.7%、71.1%、5.0%和 99.8%；东部创伤外科学会标准为 79.2%、82.7%、7.1%和 99.6%；犹他标准为 45.8%、95.8%、15.5%和 99.1%；McGovern 标准为 75.0%、89.5%、10.7%和 99.5%。
结论
在这项大型多中心儿科队列研究中，孟菲斯标准的敏感性最高（91.7%），漏诊的 BCVI 最少，而犹他评分的特异性最高（95.8%），但漏诊的损伤超过半数。需要开发一种工具，在保留其敏感性的同时缩小孟菲斯标准的范围，以便在儿科患者中应用。
证据水平
诊断性试验/标准；Ⅱ级。
Zotero 插件