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Pediatric Intracerebral Hemorrhage Management-Consensus Statement of the International Pediatric Stroke
Grégoire Boulouis1,2, Christine K Fox3, Michaela Waak4
1Diagnostic and Interventional Neuroradiology CIC-IT 1415, CHRU de Tours, INSERM 1253 iBrain Tours Centre Val de Loire France.
Insights
New guidelines offer expert consensus for managing pediatric intracerebral hemorrhage (pICH), a serious condition. These recommendations aim to standardize care and improve outcomes for children experiencing brain bleeds.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Pediatric Stroke
Background:
- Pediatric intracerebral hemorrhage (pICH) is a significant cause of pediatric stroke with high morbidity.
- Existing evidence-based guidelines for pICH management are lacking.
- pICH remains understudied despite its prevalence in pediatric stroke cases.
Purpose of the Study:
- To develop a comprehensive, consensus-based framework for the acute evaluation and management of pICH in children.
- To address the need for structured, expert-driven guidance in pICH care.
- To reduce practice variability and identify research gaps in pediatric brain hemorrhage.
Main Methods:
- Convened a multidisciplinary international working group (2020) of pediatric stroke specialists.
- Conducted systematic literature reviews and formulated clinical questions.
- Utilized a modified Delphi process to derive 21 consensus statements across key management domains.
Main Results:
- Developed 21 consensus statements on pICH acute evaluation and management.
- Achieved international, multidisciplinary, and multisociety endorsement.
- Provided structured guidance for prehospital care, diagnostics, neurocritical care, and interventions.
Conclusions:
- This is the first international consensus statement for acute pICH management in children.
- The consensus statements offer expert-driven guidance to clinicians worldwide.
- Aims to improve clinical decision-making and outcomes for children with pICH.
Abstract:
Pediatric intracerebral hemorrhage (pICH) is a rare but serious neurologic emergency associated with significant morbidity. Although pICH accounts for nearly half of all pediatric strokes, it remains understudied, and dedicated evidence-based management guidelines are lacking. To address this gap, the International Pediatric Stroke Organization convened a multidisciplinary international working group in 2020 to develop a comprehensive, consensus-based framework for the acute evaluation and management of pICH in children aged 28 days to 18 years. The working group included child neurologists, neurointensivists, neurosurgeons, neuroradiologists, and neurointerventionalists. Subgroups conducted systematic literature reviews and formulated key clinical questions. A modified Delphi process was used to derive consensus statements across 6 domains: prehospital and emergency care, diagnostic imaging and workup, neurocritical care and medical management, neurosurgical and neurointerventional approaches, and identification of knowledge gaps. Through rounds of structured review and voting, 21 consensus statements were developed and approved. The process was endorsed by multiple professional societies. This represents the first international, multidisciplinary, multisociety consensus statement focused on the acute management of pICH in children. It provides structured, expert-driven guidance to inform clinical decision-making, reduce practice variability, and highlight areas for future research. These consensus statements aim to support clinicians worldwide in improving outcomes for children with pICH.
