Traumatic intraventricular haemorrhages: clinical indicators determining morbidity and mortality in paediatric...

Intracranial haemorrhages and traumatic brain injury are significant causes of morbidity and mortality in paediatric patients. Traumatic intraventricular haemorrhage (tIVH) is the least common type of intracranial haemorrhage and typically occurs in association with other intracranial injuries. This study aimed to describe the clinical characteristics of children diagnosed with tIVH, and to identify risk factors associated with poor prognosis. Paediatric patients diagnosed with tIVH in the paediatric emergency department between January 2010 and December 2024 were retrospectively reviewed. Demographic and clinical characteristics, laboratory and imaging results, treatment modalities, and outcomes were analysed. Neurological status at discharge was assessed using the Glasgow Outcome Scale-Extended (GOSE). Among the 785 patients with traumatic intracranial haemorrhage, tIVH was identified in 41 (5.2%). Most patients were male (68.3%), with a median age of 12.8 years (6.6-15.7). The most common mechanism of injury was traffic-related trauma (78.1%). Altered consciousness was observed in 87.8% (n = 36), convulsive seizures in 17.1% (n = 7), and a Glasgow Coma Scale (GCS) score below 9 on admission in 80.5% (n = 33). Isolated tIVH was observed in only three patients (7.3%). Overall, 82.9% of patients (n = 34) required admission to the intensive care unit, and the mortality rate was 34.1% (n = 14). Only 31.6% of patients achieved a good neurological outcome; notably, all patients with isolated tIVH had favourable outcomes. Low admission GCS, coagulopathy, concomitant subdural haemorrhage, and cerebral herniation were significantly associated with both poor neurological outcome and mortality. In addition, bilateral haemorrhage, cerebral oedema, and midline shift were associated with poor neurological outcome, whereas fourth ventricular haemorrhage, concomitant skull fracture, maxillofacial trauma, and abdominal trauma were significantly associated with mortality (p < 0.05).

Low admission GCS, coagulopathy, and associated cranial or extracranial injuries are strong predictors of poor prognosis in pediatric tIVH, whereas isolated tIVH is associated with favourable neurological outcomes. Early identification of high-risk features may improve outcomes in pediatric tIVH.

• Traumatic intraventricular haemorrhage (tIVH) is a rare complication of paediatric traumatic brain injury, typically resulting from high-energy trauma such as traffic accidents, and frequently coexists with other severe intracranial injuries. • While isolated tIVH is known to follow a favourable and self-limited course, the presence of tIVH in the context of multitrauma is generally associated with high rates of morbidity and mortality.

• This study demonstrates that poor neurological outcomes and mortality in paediatric tIVH are driven primarily by the severity of concomitant injuries rather than the tIVH itself. • Specific clinical and radiological features, such as coagulopathy, concomitant subdural haemorrhage, bilateral haemorrhagic involvement, midline shift, cerebral oedema, fourth ventricular involvement, and concurrent abdominal trauma, were identified as strong prognostic markers in this population.