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Updated: Nov 9, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis
Grégoire Boulouis1,2, Sarah Stricker3, Sandro Benichi3
11Service d'imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris.
Insights
Pediatric intracerebral hemorrhage (pICH) has a high mortality rate, with 1 in 6 children dying. Most survivors experience long-term neurological deficits, though vascular causes show better outcomes.
Area of Science:
- Neurology
- Pediatrics
- Clinical Outcomes Research
Background:
- Clinical outcomes for pediatric intracerebral hemorrhage (pICH) are not comprehensively reported.
- Understanding pICH outcomes is crucial for improving pediatric neurological care.
Purpose of the Study:
- To comprehensively describe the clinical outcomes of pediatric intracerebral hemorrhage (pICH).
- To conduct a pooled analysis of existing data and a new cohort to assess pICH outcomes.
Main Methods:
- A prospective cohort study of children treated for pICH was combined with a systematic review of literature since 1990.
- Data from 231 patients in the cohort and 19 studies (pooled via meta-analysis) were analyzed.
- Clinical outcomes, including favorable outcomes, residual deficits, and case-fatality rates, were assessed.
Main Results:
- Of 231 patients, 57.4% had a favorable outcome, with 44% of those having no residual symptoms.
- The meta-analysis showed a 27% complete recovery rate overall and a 48.1% rate among those with residual deficits.
- The aggregate case-fatality rate for pICH was 17.3%.
Conclusions:
- Pediatric intracerebral hemorrhage (pICH) results in significant mortality (1 in 6 children) and a high prevalence of residual neurological deficits.
- Children with pICH caused by vascular lesions demonstrated significantly better clinical functional outcomes.
Objective:
The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH.
Methods:
Children who received treatment for pICH at the authors' institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes.
Results:
Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6-12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13-63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%-36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%-57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%-24%; Q = 101.6; I2 = 81%).
Conclusions:
Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.
