{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:51:13Z","timestamp":1780098673021,"version":"3.54.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors collected data from the Kids\u2019 Inpatient Database (KID), a nationally representative database of pediatric admissions, for years 2000, 2003, 2006, 2009, and 2012.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>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\u20133 years) and oldest age groups comprising adolescents (14\u201317 years) and young adults (18\u201320 years). BCVIs were associated with cervical (adjusted OR [aOR] 4.6, 95% CI 3.8\u20135.5), skull base (aOR 3.0, 95% CI 2.5\u20133.6), clavicular (aOR 1.4, 95% CI 1.1\u20131.8), and facial (aOR 1.2, 95% CI 1.0\u20131.5) fractures, as well as intracranial hemorrhage (aOR 2.7, 95% CI 2.2\u20133.2) and traumatic brain injury (aOR 2.0, 95% CI 1.7\u20132.3). Mechanism of injury was also independently associated with BCVI: motor vehicle collision (aOR 1.7, 95% CI 1.3\u20132.2) and struck pedestrian (aOR 1.4, 95% CI 1.0\u20131.9). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.5.peds18765","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T21:54:25Z","timestamp":1570226065000},"page":"451-460","source":"Crossref","is-referenced-by-count":10,"title":["Blunt cerebrovascular injury in pediatric trauma: a national database study"],"prefix":"10.3171","volume":"24","author":[{"given":"Dominic A.","family":"Harris","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle E.","family":"Sorte","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandi K.","family":"Lam","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children\u2019s Hospital Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1097\/TA.0b013e31829d3526","article-title":"Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study","volume":"75","author":"Azarakhsh N","year":"2013","unstructured":"Azarakhsh N, Grimes S, Notrica DM, Raines A, Garcia NM, Tuggle DW, : Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study. J Trauma Acute Care Surg 75:1006\u20131012, 20132425667410.1097\/TA.0b013e31829d3526"},{"key":"b2","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1097\/TA.0b013e3181c1c1d6","article-title":"Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries","volume":"67","author":"Biffl WL","year":"2009","unstructured":"Biffl WL, Cothren CC, Moore EE, Kozar R, Cocanour C, Davis JW, : Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. J Trauma 67:1150\u20131153, 200910.1097\/TA.0b013e3181c1c1d620009659"},{"key":"b3","series-title":"J Trauma","first-page":"471","article-title":"Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma","volume":"68","author":"Bromberg WJ","year":"2010","unstructured":"Bromberg WJ, Collier BC, Diebel LN, Dwyer KM, Holevar MR, Jacobs DG, : Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma 68:471\u2013477, 201020154559"},{"key":"b4","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1097\/TA.0b013e318246c516","article-title":"Blunt cerebrovascular injuries in children: broadened screening guidelines are warranted","volume":"72","author":"Burlew CC","year":"2012","unstructured":"Burlew CC, Biffl WL, Moore EE: Blunt cerebrovascular injuries in children: broadened screening guidelines are warranted. J Trauma Acute Care Surg 72:1120\u20131121, 20122249164410.1097\/TA.0b013e318246c516"},{"key":"b5","series-title":"J Trauma Acute Care Surg","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/TA.0000000000001631","article-title":"A cohort study of blunt cerebrovascular injury screening in children: are they just little adults?","volume":"84","author":"Cook MR","year":"2018","unstructured":"Cook MR, Witt CE, Bonow RH, Bulger EM, Linnau KF, Arbabi S, : A cohort study of blunt cerebrovascular injury screening in children: are they just little adults? J Trauma Acute Care Surg 84:50\u201357, 20182864077810.1097\/TA.0000000000001631"},{"key":"b6","series-title":"Arch Surg","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1001\/archsurg.2009.111","article-title":"Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents","volume":"144","author":"Cothren CC","year":"2009","unstructured":"Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL: Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg 144:685\u2013690, 20091962055110.1001\/archsurg.2009.111"},{"key":"b7","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1097\/00005373-199012000-00013","article-title":"Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment","volume":"30","author":"Davis JW","year":"1990","unstructured":"Davis JW, Holbrook TL, Hoyt DB, Mackersie RC, Field TO Jr, Shackford SR: Blunt carotid artery dissection: incidence, associated injuries, screening, and treatment. J Trauma 30:1514\u20131517, 199010.1097\/00005373-199012000-000132258964"},{"key":"b8","series-title":"Semin Pediatr Surg","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1053\/j.sempedsurg.2017.01.003","article-title":"Blunt cerebrovascular injury in children","volume":"26","author":"Fenton SJ","year":"2017","unstructured":"Fenton SJ, Bollo RJ: Blunt cerebrovascular injury in children. Semin Pediatr Surg 26:2\u20137, 201710.1053\/j.sempedsurg.2017.01.00328302280"},{"key":"b9","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3171\/2016.7.JNS16849","article-title":"Reliability assessment of the Biffl Scale for blunt traumatic cerebrovascular injury as detected on computer tomography angiography","volume":"127","author":"Foreman PM","year":"2017","unstructured":"Foreman PM, Griessenauer CJ, Kicielinski KP, Schmalz PGR, Rocque BG, Fusco MR, : Reliability assessment of the Biffl Scale for blunt traumatic cerebrovascular injury as detected on computer tomography angiography. J Neurosurg 127:32\u201335, 20172776740010.3171\/2016.7.JNS16849"},{"key":"b10","series-title":"Cerebrovasc Dis Extra","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1159\/000455391","article-title":"Blunt traumatic extracranial cerebrovascular injury and ischemic stroke","volume":"7","author":"Foreman PM","year":"2017","unstructured":"Foreman PM, Harrigan MR: Blunt traumatic extracranial cerebrovascular injury and ischemic stroke. Cerebrovasc Dis Extra 7:72\u201383, 201710.1159\/00045539128399527"},{"key":"b11","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1227\/NEU.0b013e3181fe2fda","article-title":"Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury","volume":"68","author":"Fusco MR","year":"2011","unstructured":"Fusco MR, Harrigan MR: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 68:517\u2013530, 201110.1227\/NEU.0b013e3181fe2fda21135751"},{"key":"b12","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1055\/s-0036-1579552","article-title":"Blunt cerebrovascular injury in cervical spine fractures: are more-liberal screening criteria warranted?","volume":"6","author":"Grabowski G","year":"2016","unstructured":"Grabowski G, Robertson RN, Barton BM, Cairns MA, Webb SW: Blunt cerebrovascular injury in cervical spine fractures: are more-liberal screening criteria warranted? Global Spine J 6:679\u2013685, 201610.1055\/s-0036-157955227781188"},{"key":"b13","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1089\/neu.2013.3309","article-title":"Incidence and trends in the diagnosis of traumatic extracranial cerebrovascular injury in the Nationwide Inpatient Sample database, 2003\u20132010","volume":"31","author":"Harrigan MR","year":"2014","unstructured":"Harrigan MR, Falola MI, Shannon CN, Westrick AC, Walters BC: Incidence and trends in the diagnosis of traumatic extracranial cerebrovascular injury in the Nationwide Inpatient Sample database, 2003\u20132010. J Neurotrauma 31:1056\u20131062, 201410.1089\/neu.2013.3309"},{"key":"b14","series-title":"World J Emerg Surg","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1749-7922-6-11","article-title":"Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice","volume":"6","author":"Harrigan MR","year":"2011","unstructured":"Harrigan MR, Weinberg JA, Peaks YS, Taylor SM, Cava LP, Richman J, : Management of blunt extracranial traumatic cerebrovascular injury: a multidisciplinary survey of current practice. World J Emerg Surg 6:11, 20112147730410.1186\/1749-7922-6-11"},{"key":"b15","series-title":"Introduction to the HCUP KIDS\u2019 Inpatient Database (KID), 2009","author":"Healthcare Cost and Utilization Project","year":"2012","unstructured":"Healthcare Cost and Utilization Project: Introduction to the HCUP KIDS\u2019 Inpatient Database (KID), 2009. Rockville, MD: Agency for Healthcare Research and Quality, 2012 (https:\/\/www.hcup-us.ahrq.gov\/db\/nation\/kid\/kid_2009_introduction.jsp) [Accessed May 24, 2019]"},{"key":"b16","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.amjsurg.2011.07.015","article-title":"Blunt cerebrovascular injuries in the child","volume":"204","author":"Jones TS","year":"2012","unstructured":"Jones TS, Burlew CC, Kornblith LZ, Biffl WL, Partrick DA, Johnson JL, : Blunt cerebrovascular injuries in the child. Am J Surg 204:7\u201310, 201210.1016\/j.amjsurg.2011.07.015"},{"key":"b17","series-title":"J Trauma","first-page":"559","article-title":"Risk factors for blunt cerebrovascular injury in children: do they mimic those seen in adults?","volume":"71","author":"Kopelman TR","year":"2011","unstructured":"Kopelman TR, Berardoni NE, O\u2019Neill PJ, Hedayati P, Vail SJ, Pieri PG, : Risk factors for blunt cerebrovascular injury in children: do they mimic those seen in adults? J Trauma 71:559\u2013564, 201121908994"},{"key":"b18","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1159\/000028804","article-title":"Pediatric blunt carotid injury: a review of the National Pediatric Trauma Registry","volume":"30","author":"Lew SM","year":"1999","unstructured":"Lew SM, Frumiento C, Wald SL: Pediatric blunt carotid injury: a review of the National Pediatric Trauma Registry. Pediatr Neurosurg 30:239\u2013244, 199910.1159\/00002880410461070"},{"key":"b19","series-title":"J Pediatr Surg","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.1016\/j.jpedsurg.2011.03.007","article-title":"Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review","volume":"46","author":"Mohseni S","year":"2011","unstructured":"Mohseni S, Talving P, Branco BC, Chan LS, Lustenberger T, Inaba K, : Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review. J Pediatr Surg 46:1771\u20131776, 201110.1016\/j.jpedsurg.2011.03.00721929988"},{"key":"b20","series-title":"J Neuroimaging","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1111\/j.1552-6569.2011.00690.x","article-title":"The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings\u2014part 2","volume":"22","author":"Pinto PS","year":"2012","unstructured":"Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TA: The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings\u2014part 2. J Neuroimaging 22:e18\u2013e41, 201210.1111\/j.1552-6569.2011.00690.x"},{"key":"b21","series-title":"J Neuroimaging","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1111\/j.1552-6569.2011.00688.x","article-title":"The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings\u2014part 1","volume":"22","author":"Pinto PS","year":"2012","unstructured":"Pinto PS, Poretti A, Meoded A, Tekes A, Huisman TA: The unique features of traumatic brain injury in children. Review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications and their imaging findings\u2014part 1. J Neuroimaging 22:e1\u2013e17, 201210.1111\/j.1552-6569.2011.00688.x"},{"key":"b22","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1089\/neu.2016.4415","article-title":"Predicting blunt cerebrovascular injury in pediatric trauma: validation of the \u201cUtah Score\u201d","volume":"34","author":"Ravindra VM","year":"2017","unstructured":"Ravindra VM, Bollo RJ, Sivakumar W, Akbari H, Naftel RP, Limbrick DD Jr, : Predicting blunt cerebrovascular injury in pediatric trauma: validation of the \u201cUtah Score\u201d. J Neurotrauma 34:391\u2013399, 201710.1089\/neu.2016.441527297774"},{"key":"b23","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"599","DOI":"10.3171\/2014.11.PEDS14397","article-title":"Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study","volume":"15","author":"Ravindra VM","year":"2015","unstructured":"Ravindra VM, Riva-Cambrin J, Sivakumar W, Metzger RR, Bollo RJ: Risk factors for traumatic blunt cerebrovascular injury diagnosed by computed tomography angiography in the pediatric population: a retrospective cohort study. J Neurosurg Pediatr 15:599\u2013606, 20152574595210.3171\/2014.11.PEDS14397"},{"key":"b24","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"307","DOI":"10.3171\/2013.12.PEDS13223","article-title":"Computed tomography characteristics in pediatric versus adult traumatic brain injury","volume":"13","author":"Sarkar K","year":"2014","unstructured":"Sarkar K, Keachie K, Nguyen U, Muizelaar JP, Zwienenberg-Lee M, Shahlaie K: Computed tomography characteristics in pediatric versus adult traumatic brain injury. J Neurosurg Pediatr 13:307\u2013314, 20142441012810.3171\/2013.12.PEDS13223"},{"key":"b25","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1097\/TA.0b013e318142d146","article-title":"Blunt cerebrovascular injuries: does treatment always matter?","volume":"66","author":"Stein DM","year":"2009","unstructured":"Stein DM, Boswell S, Sliker CW, Lui FY, Scalea TM: Blunt cerebrovascular injuries: does treatment always matter? J Trauma 66:132\u2013144, 200910.1097\/TA.0b013e318142d14619131816"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/24\/4\/article-p451.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/24\/4\/article-p451.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/24\/4\/article-p451.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T12:53:26Z","timestamp":1681563206000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/24\/4\/article-p451.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":25,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2019.5.peds18765","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}