Written by Millie Cossé
Spoon Feed
This prospective cohort study has identified five injuries that are highly associated with pediatric blunt cerebrovascular injury: temporal fractures, sphenoid fractures, orbital roof fractures, fractures of C1-4, and ligamentous injuries of the cervical spine.
A+ work from the ATOMAC+ group here
Pediatric blunt cerebrovascular injury (BVCI) is a rare but potentially devastating traumatic injury with a subsequent stroke risk of up to 20%. Prompt recognition and treatment can reduce that risk to 0.3%. Current guidelines for identification and management of BCVI in pediatric trauma patients are largely based on adult data, and previous studies lack robust follow-up protocols, which raises the concern that these studies may have failed to account for missed diagnosis.
Enter the A+ criteria for BCVI screening, which is based on a prospective observational cohort study including 1,327 pediatric patients who all had follow-up – the largest prospective study to date. Using a multivariable logistic regression analysis, the authors found that temporal fracture, sphenoid fracture, orbital roof fracture, C1-4 fracture, and ligamentous injury of the cervical spine are significantly associated with BCVI. Almost as interesting as the injuries that are associated with BCVI are the ones this study could not validate. For example, mandible fractures, soft tissue injuries of the neck, and seatbelt bruising of the neck were not significantly associated with BCVI in this study.
How does this change my practice?
This study has a few limitations; it may be underpowered (though true incidence is difficult to determine, assuming we are missing injuries using current guidelines) and the A+ criteria still require validation. However, this is a high-quality, pediatric-only prospective study with robust follow-up, and I will be referencing the A+ criteria as a supplement to current guidelines until this work has been validated.
Source
The A+ criteria for pediatric blunt cerebrovascular injury: An ATOMAC+ multicenter study. J Trauma Acute Care Surg. 2025 Jun 13. doi: 10.1097/TA.0000000000004686. Epub ahead of print. PMID: 40506814
Appropriate ; cta cervical