Citation

Ravindra VM, Bollo R, Sivakumar W, Akbari H, Naftel RP, Limbrick DD, Jea A, Gannon SR, Shannon C, Birkas Y, Yang GL, Prather CT, Kestle J, Riva-Cambrin J. J. Neurotrauma 2016; 34(2): 391-399.

Affiliation

University of Utah School of Medicine, 12348, Department of Neurosurgery, Division of Pediatric Neurosurgery, Salt Lake City, Utah, United States ; neuropub@hsc.utah.edu.

Copyright

(Copyright © 2016, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4415

PMID

27297774

Abstract

Risk factors for blunt cerebrovascular injury (BCVI) may differ between children and adults, suggesting that children at low risk for BCVI after trauma receive unnecessary computed tomography angiography (CTA) and high-dose radiation. We previously developed a score for predicting pediatric BCVI based on retrospective cohort analysis. Our objective is to externally validate this prediction score with a retrospective multi-institutional cohort. We included patients who underwent CTA for traumatic cranial injury at four pediatric level-one trauma centers. Each patient in the validation cohort was scored using the "Utah Score" and classified as high or low risk. Before analysis, we defined a misclassification rate <25% as validating the "Utah Score." Six hundred forty-five patients (103±64.6 months; 63.4% males) underwent screening for BCVI via CTA. The validation cohort was 411 patients from three sites compared with the training cohort of 234 patients. Twenty-two BCVIs (5.4%) were identified in the validation cohort. The "Utah Score" was significantly associated with BCVIs in the validation cohort (OR 8.1 [3.3, 19.8], p<0.001) and discriminated well in the validation cohort (AUC 72%). When the "Utah Score" was applied to the validation cohort, the sensitivity was 59%, specificity was 85%, positive predictive value was 18%, and negative predictive value was 97%. The "Utah Score" misclassified 16.6% of patients in the validation cohort. The "Utah Score" for predicting BCVI in pediatric trauma patients was validated with a low misclassification rate using a large, independent, multi-center cohort. Its implementation in the clinical setting may reduce use of CTA in low-risk patients.

Language: en