目的:小儿口咽部创伤很常见。尽管大多数案件都能顺利解决,有报道称颈内动脉损伤会导致毁灭性的神经血管后遗症。对于看似轻微口咽外伤的儿童,CT血管造影(CTA)的实用性存在重大争议。这项研究的目的是根据CTA结果评估诊断和治疗的变化。
方法:对PubMed的全面搜索,Embase,CINAHL,Scopus,Cochrane耳朵,鼻子和喉咙疾病小组试验登记册,ClinicalTrials.gov数据库按照PRISMA指南进行。
结果:搜索产生了5,078个独特的摘要,其中包括8篇文章。共纳入662例患者,293有任何CT头颈部成像,和255与CTA。在CTA上发现了11个颈动脉损伤/异常,包括颈动脉周围的水肿(n=8),潜在的内膜撕裂(n=1),颈动脉痉挛(n=1),颈动脉压迫(n=1)。可能导致临床管理变化的CTA影像学表现的合并比例为0.00(95%CI0.00-0.43)。对10例患者进行了血管造影,6例因CTA异常。血管造影确定了1例血管痉挛患者和2例颈动脉内膜破裂无血栓患者。无患者行血管修复或脑血管损伤。
结论:CTA成像在少数情况下产生放射学异常。这些结果不支持常规使用CTA筛查小儿口咽外伤时,平衡辐射的风险,因为它很少导致管理变更,并且没有显示改善结果。
方法:N/A喉镜,133:457-466,2023年。
Pediatric oropharyngeal trauma is common. Although most cases resolve uneventfully, there have been reports of internal carotid artery injury leading to devastating neurovascular sequelae. There is significant controversy regarding the utility of CT angiography (CTA) in children with seemingly minor oropharyngeal trauma. The goal of this study was to appraise changes in diagnosis and treatment based on CTA results.
A comprehensive search of PubMed, Embase, CINAHL, Scopus, the Cochrane Ear, Nose and Throat Disorders Group Trials Register, and the ClinicalTrials.gov database was performed following PRISMA guidelines.
The search yielded 5,078 unique abstracts, of which 8 articles were included. A total of 662 patients were included, with 293 having any CT head/neck imaging, and 255 with CTA. Eleven injuries/abnormalities of the carotid were found on CTAs, comprising edema around the carotid (n = 8), potential intimal tear (n = 1), carotid spasm (n = 1), and carotid compression (n = 1). The pooled proportion of imaging findings on CTA that could lead to changes in clinical management was 0.00 (95% CI 0.00-0.43). Angiography was obtained in 10 patients, in 6 cases due to abnormal CTA. Angiography identified 1 patient with vessel spasm and two patients with carotid intima disruption without thrombus. No patient underwent vascular repair or suffered cerebrovascular injury.
Imaging with CTA yielded radiological abnormalities in a few instances. These results do not support the routine use of CTA in screening pediatric oropharyngeal trauma when balanced against the risk of radiation, as it rarely resulted in management changes and was not shown to improve outcomes.
N/A Laryngoscope, 133:457-466, 2023.