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Health-related quality of life in children with congenital vascular malformations
Frédérique C M Bouwman1,2,3, Chris Verhaak4, Ivo de Blaauw5
1Department of Pediatric Surgery, Radboudumc-Amalia Children's Hospital, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. Frederique.Bouwman@radboudumc.nl.
Insights
A quarter of children with congenital vascular malformations (CVM) experience impaired health-related quality of life (HRQOL). Lower extremity CVMs and invasive management are independently associated with worse HRQOL in pediatric patients.
Area of Science:
- Pediatric Health
- Quality of Life Research
- Vascular Malformations
Background:
- Congenital vascular malformations (CVMs) can impact children's health-related quality of life (HRQOL).
- Existing research on pediatric HRQOL in CVM patients is limited, often involving small sample sizes or combined adult and pediatric data.
Purpose of the Study:
- To evaluate HRQOL in children with CVMs.
- To identify factors associated with impaired HRQOL in this population.
Main Methods:
- Cross-sectional study of 207 children (2-17 years) with CVMs.
- Utilized PedsQL 4.0 Generic Core Scales for HRQOL assessment.
- Employed logistic regression to analyze factors associated with impaired HRQOL.
Main Results:
- Median overall HRQOL was 84.8/100; 25% of patients had impaired HRQOL.
- Parental ratings of HRQOL were significantly lower than children's ratings.
- Impaired HRQOL was associated with lower extremity CVMs, multifocal CVMs, invasive management, younger age at first treatment, and ongoing treatment.
Conclusions:
- While overall median HRQOL is reasonable, a significant portion of pediatric CVM patients experience impairment.
- Lower extremity CVMs and ongoing invasive management are independent predictors of impaired HRQOL.
- Findings highlight the need for targeted interventions to improve HRQOL in affected children.
Abstract:
A cross-sectional study was performed to evaluate health-related quality of life (HRQOL) in children with congenital vascular malformations (CVM) and to investigate factors associated with an impaired HRQOL. Children (2-17 years) with CVMs who visited the HECOVAN expertise center between 2016-2018 were included. The PedsQL 4.0 Generic Core Scales were used and a score ≥ 1.0 SD below the normative mean was defined as an impaired HRQOL. Factors associated with impairment were investigated using univariate and multivariate logistic regression analysis. The median overall HRQOL was 84.8/100 (n = 207; 41% boys, 59% girls; self-reported IQR 73.9-92.4 and parent-reported IQR 71.4-92.4). Patients aged 13-17 years reported significantly worse physical functioning than those aged 8-12 years (median 84.4, IQR 71.1-93.8 versus median 90.6, IQR 81.3-96.9; p = 0.02). Parents reported a significantly lower overall HRQOL than their children (median 80.4, IQR 70.7-90.8 versus median 85.9, IQR 76.1-92.4; p = 0.001). HRQOL was impaired in 25% of patients. Impairment occurred significantly more often in lower extremity CVMs (38%, p = 0.01) and multifocal CVMs (47%, p = 0.01) compared to CVMs in the head/neck region (13%). Other associated factors included invasive management (31% versus 14%; p = 0.01), age at first treatment ≤ 5 years (48% versus 25%; p = 0.02) and ongoing treatment (38% versus 18%; p = 0.004). After correction for other factors, significance remained for lower extremity CVMs and ongoing invasive treatment.
Conclusions:
Overall median HRQOL was reasonable and not significantly different from the norm sample. Parental ratings were significantly lower than their children's ratings. A quarter of the patients had an impaired HRQOL, which seemed to worsen with age. Independently associated factors included a lower extremity CVM and invasive management.
What Is Known:
• Congenital vascular malformations could affect health-related quality of life (HRQOL). • Studies on pediatric patients are limited and either very small or in combination with adult patient series.
What Is New:
• This study raises awareness of an impaired HRQOL in 25% of pediatric patients with congenital vascular malformations. • Associated factors included a lower extremity CVM and invasive management.
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