Cost Effectiveness of Pediatric Blunt Cerebrovascular Injury Screening: A Decision Tree Analysis

Background: Early identification of blunt cerebrovascular injury in the pediatric (<18 years) population (pBVCI) is essential to minimize stroke.However, the most cost-effective screening strategy for pBCVI is unknown, and there is high variability in practice nationwide.We sought to identify the most costeffective screening strategy for identifying pBCVI and hypothesized that Memphis criteria (MC) would be the most cost-effective due to its high sensitivity.Study design: A Decision Tree analysis model was used to compare the following BCVI screening strategies in peds: (1) no screening (NS); (2) Denver criteria (DC); (3) Expanded Denver criteria (eDC); (4) MC; (5) McGovern criteria (MG); (6) Utah criteria (UC); and (7) universal screening (US).The model considered a range of pBCVI incidences (0.2e2.7 %) and analyzed costs and utilities over a 5-year time horizon.pBCVI cases detected by screening modalities were assumed to be given antithrombotic therapy which mitigates the risk of stroke and mortality.Results: Our analysis revealed that at low pBCVI incidences, UC was most cost-saving per additional quality-adjusted life year (QALY) compared to NS, while MC yielded the highest savings at high incidences compared to MG. Sensitivity analyses indicated the cost-effectiveness of screening strategies varied significantly with pBCVI incidence.Conclusions: The cost-effectiveness of pBCVI screening is contingent upon accurate incidence rates, with no one-size-fits-all solution.Pediatric trauma centers should tailor their screening strategies to local pBCVI rates to enhance cost-efficiency and patient outcomes.Further research is needed to better define BCVI incidence rates in children to inform these decisions.