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Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage

Gregoire Boulouis1,2, Jean-François Hak1,2, Basile Kerleroux1,2

  • 1GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).

Stroke
|January 11, 2021
PubMed

Insights

Significant hemorrhage expansion in children with intracerebral hemorrhage is common, especially with coagulation disorders. This expansion is linked to worse outcomes, suggesting a need for baseline coagulation tests.

Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Critical Care Medicine

Background:

  • Significant hemorrhage expansion (sHE) predicts poor outcomes in adult intracerebral hemorrhage (ICH) but is underreported in pediatric cases.
  • Understanding sHE in children is crucial for improving prognostication and management strategies.

Purpose of the Study:

  • To determine the prevalence of sHE in pediatric ICH.
  • To investigate associations between sHE and clinical outcomes in children.
  • To identify clinical and imaging predictors of sHE in pediatric ICH.

Main Methods:

  • Retrospective analysis of pediatric ICH patients (2000-2020) with two CT scans within 72 hours.
  • sHE defined as ≥6 cc or 33% increase in ICH volume on follow-up CT.
  • Clinical outcomes assessed at 12 months using the King's Outcome Scale for Childhood Head Injury (KOSHI).

Main Results:

  • 15% of pediatric ICH patients (8/52) showed sHE; 34.6% had any expansion.
  • sHE was significantly associated with baseline coagulation disorders (25% vs 2.3%, P=0.022).
  • sHE independently predicted poor clinical outcomes (KOSHI <5, OR 5.77, P=0.043).

Conclusions:

  • Significant hemorrhage expansion is a frequent event in pediatric ICH, particularly in those with coagulation defects.
  • sHE is strongly associated with poorer long-term clinical outcomes in children.
  • Findings support baseline coagulation workup and may inform the need for routine repeat head CT in pediatric ICH.
Abstract

Keywords:
coagulation disorderscomputed tomographyhospitals, pediatricodds ratioprevalence

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