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Published on: October 20, 2017
Association of Physiologic Parameters with Neurologic Outcome After Arteriovenous Malformation Rupture in Children
Julia S Keenan1, Claire Har1, Florence Yan2
1Division of Neurology, Children's National Hospital, Washington, DC, USA.
Insights
Maintaining normal temperature and blood glucose levels in children with ruptured brain arteriovenous malformations significantly improves outcomes. These critical care parameters, along with hemoglobin and carbon dioxide levels, are key targets for quality improvement interventions.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neurovascular Surgery
Background:
- Critical care management guidelines for pediatric ruptured brain arteriovenous malformations (bAVMs) are limited.
- Ruptured bAVMs in children often lead to poor neurological outcomes.
Purpose of the Study:
- To investigate associations between physiological parameters and outcomes in pediatric patients with ruptured bAVMs.
- To identify potentially modifiable factors for improving outcomes in this patient population.
Main Methods:
- Single-center retrospective review of pediatric patients (≤18 years) with ruptured bAVMs from 2011 to 2023.
- Outcome assessment using the Pediatric Stroke Outcome Measure.
- Descriptive statistics and inferential analyses to determine associations between physiological parameters and outcomes.
Main Results:
- A majority of pediatric patients (63%) experienced poor outcomes at discharge, with 57% having poor outcomes at 3-12 month follow-up.
- Normothermia and normoglycemia in the first 7 days post-rupture were associated with significantly better discharge outcomes (OR 0.14, P=.01 and OR 0.11, P=.04, respectively).
- Lower minimum hemoglobin and higher average partial pressure of carbon dioxide (Paco2) were linked to poor discharge outcomes (P=.04 and P=.046, respectively). Higher average maximum temperature correlated with poor follow-up outcomes (P=.04).
Conclusions:
- Physiological parameters including temperature, blood glucose, hemoglobin, and Paco2 are associated with outcomes in children with ruptured bAVMs.
- These modifiable parameters represent potential targets for quality improvement initiatives aimed at enhancing patient outcomes.
Abstract:
Evidence to guide the critical care management of children with ruptured brain arteriovenous malformations is lacking. We aimed to determine whether there are associations between physiologic parameters and outcome in children with ruptured brain arteriovenous malformations. We performed a single-center retrospective review of patients ≤18 years of age with a ruptured brain arteriovenous malformation from 2011 to 2023. Categorization of outcome was based on the Pediatric Stroke Outcome Measure. Descriptive statistics were used. Most patients with an arteriovenous malformation rupture had a poor outcome at discharge (31/49, 63%) and in follow-up at 3-12 months (21/37, 57%). Patients who were normothermic and normoglycemic for the first 7 days after arteriovenous malformation rupture were less likely to have a poor outcome at discharge than those who had a temperature ≥38 °C (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.52; P = .01) or a blood glucose ≥200 mg/dL (OR 0.11, 95% CI 0.01-0.92; P = .04). A lower minimum hemoglobin concentration (10.00 g/dL [standard deviation (SD) 1.67] vs 12.46 g/dL [SD 6.29], t(47) 2.07, P = .04) and a higher average partial pressure of carbon dioxide (Paco2) (40.98 mm Hg [SD 4.30] vs 35.58 mm Hg [SD 7.72], t(47) -2.09, P = .046) were also associated with a poor discharge outcome. A higher average maximum temperature was associated with a poor outcome in follow-up (37.46° C [SD 0.49] vs 37.09 °C [SD 0.59], t(47) -2.09; P = .04). Temperature, blood glucose, hemoglobin concentration, and Paco2 are potentially modifiable parameters that could be targeted by quality improvement interventions to improve outcomes in this population.
