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Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma
Richard Lichenstein1, Todd F Glass, Kimberly S Quayle
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. rlichenstein@peds.umaryland.edu
Insights
Children with non-isolated intraventricular hemorrhages (IVHs) from blunt head trauma (BHT) face high mortality and neurosurgery needs. Isolated IVHs in children present with normal mental status and good outcomes.
Area of Science:
- Pediatric Traumatology
- Neurocritical Care
- Emergency Medicine
Background:
- Intraventricular hemorrhages (IVHs) are a serious complication of blunt head trauma (BHT) in children.
- Understanding the clinical spectrum and outcomes of pediatric IVHs is crucial for effective management.
Purpose of the Study:
- To delineate the clinical presentations and outcomes of pediatric patients experiencing intraventricular hemorrhages following blunt head trauma.
- To differentiate outcomes based on the presence of isolated versus non-isolated IVHs.
Main Methods:
- A subanalysis of a large, prospective, observational cohort study.
- Inclusion of data from 25 emergency departments within the Pediatric Emergency Care Applied Research Network.
- Assessment of clinical presentations and outcomes using Glasgow Coma Scale (GCS), Pediatric Overall Performance Category (POPC), and Pediatric Cerebral Performance Category (PCPC) scores.
Main Results:
- Of 15,907 patients evaluated, 7.3% had intracranial injuries; 3.7% had non-isolated IVHs and 0.9% had isolated IVHs.
- Children with non-isolated IVHs often presented with low GCS scores, high rates of neurosurgery (41.9%), and significant mortality (37.2%).
- Conversely, children with isolated IVHs typically had GCS scores of 15, required no neurosurgery, and had favorable outcomes with no reported mortality or moderate/severe disability.
Conclusions:
- Non-isolated IVHs in pediatric blunt head trauma are associated with severe neurological compromise, frequent need for surgical intervention, and elevated mortality rates.
- Isolated IVHs in children after BHT are generally associated with normal mental status and a low risk of adverse outcomes.
- Distinguishing between isolated and non-isolated IVHs is critical for predicting prognosis and guiding clinical management in pediatric head trauma.
Objective:
To describe the clinical presentations and outcomes of children with intraventricular hemorrhages (IVHs) after blunt head trauma (BHT).
Design:
Subanalysis of a large, prospective, observational cohort study performed from June 1, 2004, through September 31, 2006.
Setting:
Twenty-five emergency departments participating in the Pediatric Emergency Care Applied Research Network. Patients Children presenting with IVH after BHT. Exposure Blunt head trauma.
Main Outcome Measures:
Clinical presentations and outcomes, including the Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scores at hospital discharge.
Results:
Of 15 907 patients evaluated with computed tomography, 1156 (7.3%) had intracranial injuries. Forty-three of the 1156 (3.7%; 95% CI, 2.7%-5.0%) had nonisolated IVHs (ie, with intracranial injuries on computed tomography), and 10 of 1156 (0.9%; 95% CI, 0.4%-1.6%) had isolated IVHs. Only 4 of 43 (9.3%) of those with nonisolated IVHs had Glasgow Coma Scale (GCS) scores of 14 to 15, and all 10 (100.0%) with isolated IVHs had GCS scores of 15. No patients with isolated IVHs required neurosurgery or died. One patient had moderate overall disability (by the POPC score), and no patient had moderate or severe disability at discharge (by the PCPC score). Of the 43 patients with nonisolated IVHs, however, 16 (37.2%) died and 18 (41.9%) required neurosurgery. In 27 patients (62.8%), injuries ranged from moderate overall disability to brain death by the POPC score.
Conclusions:
Children with nonisolated IVHs after BHT typically present with GCS scores of less than 14, frequently require neurosurgery, and have high mortality rates. In contrast, those with isolated IVHs typically present with normal mental status and are at low risk for acute adverse events and poor outcomes.
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