The Utility of CTA in Pediatric Oropharyngeal Trauma: A Systematic Review and Meta-Analysis.

Autor: Poupore NS; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.; University of South Carolina School of Medicine Greenville, Greenville, South Carolina, U.S.A., Jungbauer WN; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.; University of Minnesota Medical School, Minneapolis, Minnesota, U.S.A., Nguyen SA; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., White DR; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Pecha PP; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A., Carroll WW; Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
Jazyk: angličtina
Zdroj: The Laryngoscope [Laryngoscope] 2023 Jan; Vol. 133 (1), pp. 25-37. Date of Electronic Publication: 2022 Apr 08.
DOI: 10.1002/lary.30133
Abstrakt: Objective(s): To analyze the utility of computed tomography angiography (CTA) in identifying internal carotid artery (ICA) injury and reducing cerebrovascular accident (CVA) incidence in children presenting with normal neurologic exams after oropharyngeal trauma (OT).
Data Sources: PubMed, Scopus, CINAHL, and Cochrane.
Review Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. Of 1,185 studies screened, 95 studies of pediatric OT met inclusion criteria. Meta-analysis of proportions was performed.
Results: A total of 1224 children with OT were analyzed. Excluding case reports, the weighted proportion of a CVA after OT was 0.31% (95% CI 0.06-0.93). If a child presented without neurologic deficits, 0.30% (95% CI 0.05-0.95) returned with new neurologic deficits. An ICA injury was identified in 0.89% (95% CI 0.16-2.74) of screening CTAs. No difference in CVA incidence was seen in children with screening CTA (0.52% [95% CI 0.02-2.15]) compared to children without screening CTA (0.42% [95% CI 0.06-1.37]). Patients who developed CVA had a higher proportion of injuries >2 cm, injuries at the posterior pillar or tonsil, and injuries with a writing utensil or popsicle stick compared to patients without CVA.
Conclusion: The proportion of children experiencing an ICA injury leading to CVA after sustaining OT is low. CTAs infrequently show ICA changes in children with normal neurological exams. Children who receive CTAs do not have a significantly lower incidence of CVAs than children who do not receive CTAs. Clinicians should weigh the risks and benefits of a CTA based on an individual child's presentation and discuss this with caregivers for shared decision-making. Laryngoscope, 133:25-37, 2023.
(© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)
Databáze: MEDLINE
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