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Epidemiology and Outcomes of Cerebral Edema in Hospitalized Children
Leanna Laor1, Prithvi Sendi2, Paul Martinez2
1Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, Florida.
Insights
Cerebral edema in children is rare but serious, often caused by stroke or anoxic brain injury. While anoxic injury leads to high mortality, diabetic ketoacidosis is associated with the lowest risk.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Epidemiology
Background:
- Cerebral edema, a dangerous condition, can arise from various diseases in children.
- Prompt management is crucial, yet outcomes can be severe.
Purpose of the Study:
- To determine the prevalence, causes, and outcomes of cerebral edema in hospitalized children.
- To identify risk factors influencing mortality in pediatric cerebral edema cases.
Main Methods:
- Retrospective cross-sectional study utilizing the 2016 Kids' Inpatient Database.
- Analysis included children aged one month to 20 years, with national estimates derived from weighted samples.
- Logistic regression assessed demographic and etiological factors impacting mortality.
Main Results:
- Cerebral edema occurred in 2.2 per 1000 pediatric hospital discharges (4903 cases).
- Leading causes included stroke (21.7%), anoxic injury (21.4%), and CNS malignancy (16%).
- Overall mortality was 29.4%, significantly higher with anoxic injury (84%) but lower with CNS malignancy (9.5%) and diabetic ketoacidosis (4.3%).
Conclusions:
- Cerebral edema is an uncommon but high-mortality condition in hospitalized children.
- Stroke and anoxic brain injury are the primary causes in the US.
- Anoxic brain injury carries the highest mortality risk, while diabetic ketoacidosis has the lowest.
Background:
Cerebral edema can be a consequence of multiple disease processes. Untreated cerebral edema can be fatal, and even with aggressive management, it can be devastating. The objective of this study was to describe the prevalence, underlying causes, and outcomes of cerebral edema in hospitalized children.
Methods:
A retrospective cross-sectional study using the 2016 Kids' Inpatient Database was performed. Children aged one month to 20 years were included. Sample weighting was employed to produce national estimates. Univariate analyses were used to compare those who died and survived. Multivariable logistic regression was performed to assess the influence of demographic variables and etiologic factors on mortality.
Results:
Cerebral edema was documented in 4903 children of 2,210,263 (2.2 of 1000) discharges. Among children with cerebral edema, males were 57%, white children were 47.9%, and adolescents were 48.9%. The three most common etiologies associated with cerebral edema in this cohort were stroke (21.7%), anoxic injury (21.4%), and central nervous system (CNS) malignancy (16%). The overall hospital mortality rate was 29.4%. The adjusted mortality rate was significantly higher when cerebral edema was associated with anoxic injury (84%). The mortality was lower when cerebral edema was associated with CNS malignancy (9.5%) or diabetic ketoacidosis (DKA) (4.3%).
Conclusions:
Cerebral edema is uncommon in hospitalized children but has a high mortality. Stroke and anoxic brain injury are the two most common etiologies for cerebral edema in hospitalized children in the United States. Among all etiologies for cerebral edema in children, anoxic brain injury has the highest mortality, whereas DKA has the lowest mortality.
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