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Neurologic Outcome Predictors in Pediatric Intracerebral Hemorrhage: A Prospective Study
Giulia S Porcari1, Lauren A Beslow, Rebecca N Ichord
1From the Vanderbilt University School of Medicine, Nashville, TN (G.S.P.).
Insights
Over a third of pediatric patients with intracerebral hemorrhage had significant disability at 2 years. Key predictors of poor neurological outcome include altered mental status and larger hemorrhage volume.
Area of Science:
- Neurology
- Pediatric Medicine
- Neurosurgery
Background:
- Intracerebral hemorrhage is a significant cause of disability and death in children.
- Understanding long-term outcomes and predictors is crucial for improving pediatric care.
Purpose of the Study:
- To describe the neurological outcomes of pediatric intracerebral hemorrhage.
- To identify predictors of 2-year neurological outcomes in children.
Main Methods:
- Prospective enrollment of 69 children (29 days to 18 years) with intracerebral hemorrhage across 3 centers.
- Exclusion of cases with trauma, tumors, or other specific hemorrhage types.
- Assessment of neurological outcomes using the Pediatric Stroke Outcome Measure and neuroimaging for volume quantification.
Main Results:
- Nine percent of children died during hospitalization; 98% of survivors had early and 94% had late follow-up (median 2.1 years).
- Over one-third of survivors had significant disability (Pediatric Stroke Outcome Measure >2) at 2 years.
- Altered mental status, hemorrhage volume (≥4% of total brain volume), and ICU length of stay independently predicted poor 2-year outcomes.
Conclusions:
- Significant disability is common in pediatric intracerebral hemorrhage survivors at 2 years.
- Improvements in sensorimotor function contributed to overall outcome recovery.
- Early identification of high-risk patients based on clinical and imaging factors is essential for targeted interventions.
Background And Purpose:
Intracerebral hemorrhage is a considerable source of morbidity and mortality. This 3-center study describes outcomes of pediatric intracerebral hemorrhage and identifies 2-year neurological outcome predictors.
Methods:
Children 29 days to 18 years of age presenting with intracerebral hemorrhage from March 2007 to May 2015 were enrolled prospectively. Exclusion criteria included trauma; intracranial tumor; hemorrhagic transformation of arterial ischemic stroke or cerebral sinovenous thrombosis; isolated subdural, epidural, or subarachnoid hemorrhage; and abnormal baseline neurological function. Intracerebral hemorrhage and total brain volumes were measured on neuroimaging. The Pediatric Stroke Outcome Measure assessed outcomes.
Results:
Sixty-nine children were included (median age: 9.7 years; interquartile range: 2.2-14). Six children (9%) died during hospitalization. Outcomes in survivors were assessed at early follow-up in 98% (median 3.1 months; interquartile range: 3.1-3.8) and at later follow-up in 94% (median: 2.1 years; interquartile range: 1.3-2.8). Over a third had a significant disability at 2 years (Pediatric Stroke Outcome Measure >2). Total Pediatric Stroke Outcome Measure score improved over time (P=0.0003), paralleling improvements in the sensorimotor subscore (P=0.0004). Altered mental status (odds ratio, 13; 95% confidence interval, 3.9-46; P<0.001), hemorrhage volume ≥4% of total brain volume (odds ratio, 17; 95% confidence interval, 1.9-156; P=0.01), and intensive care unit length of stay (odds ratio, 1.1; 95% confidence interval, 1.0-1.2; P=0.002) were significantly associated with poor 2-year outcome.
Conclusions:
Over one third of children experienced significant disability at 2 years. Improvements in outcomes were driven by recovery of sensorimotor function. Altered mental status, hemorrhage volume ≥4% of total brain volume, and intensive care unit length of stay were independent predictors of significant disability at 2 years.
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