Incidence of blunt cerebrovascular injury (BCVI) in pediatric hangings and recommendation for screening

Purpose: Incidence of blunt cerebrovascular injury (BCVI) following hanging in the pediatric population is ill-defined. Current guidelines recommend screening imaging during the initial trauma evaluation. Necessity of screening is questioned given BCVI is considered rare after hanging, especially when asymptomatic. This study aims to elucidate the incidence of BCVI in pediatric hangings and determine the value of radiographic work up. Methods A retrospective cohort study was performed, of pediatric hangings reported to the National Trauma Databank (NTDB), 2017–2019. Imaging, diagnoses, and findings suggestive of BCVI, such as Glasgow Coma Scale (GCS) ≤ 8, presence of cervical injury, and soft tissue injury were considered. Statistical analysis was carried out to compare incidence. Results 197 patients met study criteria, with 179 showing up to the trauma bay with signs of life. BCVI incidence was 5.6% (10 of 179). A CT angiogram (CTA) was completed in 46% of the patients. Conclusion BCVI incidence following pediatric hanging is more common than previously thought. Less than half of patients had a CTA reported in this cohort. This may result in an underestimate. Given the potentially devastating consequences of a missed BCVI, the addition of CTA to initial work up is worthwhile to evaluate for cervical vascular injury.