Abstract：
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).
PubMed, Scopus, CINAHL, and Cochrane.
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.
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.
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.
PubMed, Scopus, CINAHL, and Cochrane.
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.
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.
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.
摘要：
目的：分析计算机断层扫描血管造影（CTA）在识别颈内动脉（ICA）损伤和降低口咽部创伤（OT）后神经系统检查正常的儿童脑血管意外（CVA）发生率中的应用。
方法：PubMed，Scopus,CINAHL,还有Cochrane.
方法：按照PRISMA指南进行系统评价和荟萃分析。在筛选的1,185项研究中，95项儿科OT研究符合纳入标准。进行比例的Meta分析。
结果：共分析了1224例OT患儿。不包括病例报告，OT后CVA的加权比例为0.31%(95%CI0.06-0.93).如果一个孩子没有神经缺陷，0.30％（95％CI0.05-0.95）出现新的神经功能缺损。在0.89%(95%CI0.16-2.74)的筛查CTA中发现ICA损伤。与未筛查CTA的儿童(0.42%[95%CI0.06-1.37])相比，筛查CTA的儿童CVA发生率无差异(0.52%[95%CI0.06-1.37])。发生CVA的患者损伤>2厘米的比例更高，后柱或扁桃体受伤，与没有CVA的患者相比，用书写器具或冰棒棒造成的伤害。
结论：在维持OT后经历导致CVA的ICA损伤的儿童比例较低。CTA很少显示神经系统检查正常的儿童的ICA变化。与未接受CTA的儿童相比，接受CTA的儿童的CVA发生率并不明显较低。临床医生应根据个别儿童的陈述权衡CTA的风险和收益，并与护理人员讨论共同决策。喉镜,133:25-37,2023.
方法：PubMed，Scopus,CINAHL,还有Cochrane.
方法：按照PRISMA指南进行系统评价和荟萃分析。在筛选的1,185项研究中，95项儿科OT研究符合纳入标准。进行比例的Meta分析。
结果：共分析了1224例OT患儿。不包括病例报告，OT后CVA的加权比例为0.31%(95%CI0.06-0.93).如果一个孩子没有神经缺陷，0.30％（95％CI0.05-0.95）出现新的神经功能缺损。在0.89%(95%CI0.16-2.74)的筛查CTA中发现ICA损伤。与未筛查CTA的儿童(0.42%[95%CI0.06-1.37])相比，筛查CTA的儿童CVA发生率无差异(0.52%[95%CI0.06-1.37])。发生CVA的患者损伤>2厘米的比例更高，后柱或扁桃体受伤，与没有CVA的患者相比，用书写器具或冰棒棒造成的伤害。
结论：在维持OT后经历导致CVA的ICA损伤的儿童比例较低。CTA很少显示神经系统检查正常的儿童的ICA变化。与未接受CTA的儿童相比，接受CTA的儿童的CVA发生率并不明显较低。临床医生应根据个别儿童的陈述权衡CTA的风险和收益，并与护理人员讨论共同决策。喉镜,133:25-37,2023.
