Neurologic Outcome Predictors in Pediatric Intracerebral Hemorrhage: A Prospective Study.

Porcari GS, Beslow LA, Ichord RN, Licht DJ, Kleinman JT, Jordan LC
Stroke. 2018 49 (7): 1755-1758

PMID: 29895534 · PMCID: PMC6019624 · DOI:10.1161/STROKEAHA.118.021845

BACKGROUND AND PURPOSE - Intracerebral hemorrhage is a considerable source of morbidity and mortality. This 3-center study describes outcomes of pediatric intracerebral hemorrhage and identifies 2-year neurological outcome predictors.

METHODS - Children 29 days to 18 years of age presenting with intracerebral hemorrhage from March 2007 to May 2015 were enrolled prospectively. Exclusion criteria included trauma; intracranial tumor; hemorrhagic transformation of arterial ischemic stroke or cerebral sinovenous thrombosis; isolated subdural, epidural, or subarachnoid hemorrhage; and abnormal baseline neurological function. Intracerebral hemorrhage and total brain volumes were measured on neuroimaging. The Pediatric Stroke Outcome Measure assessed outcomes.

RESULTS - Sixty-nine children were included (median age: 9.7 years; interquartile range: 2.2-14). Six children (9%) died during hospitalization. Outcomes in survivors were assessed at early follow-up in 98% (median 3.1 months; interquartile range: 3.1-3.8) and at later follow-up in 94% (median: 2.1 years; interquartile range: 1.3-2.8). Over a third had a significant disability at 2 years (Pediatric Stroke Outcome Measure >2). Total Pediatric Stroke Outcome Measure score improved over time (=0.0003), paralleling improvements in the sensorimotor subscore (=0.0004). Altered mental status (odds ratio, 13; 95% confidence interval, 3.9-46; <0.001), hemorrhage volume ≥4% of total brain volume (odds ratio, 17; 95% confidence interval, 1.9-156; =0.01), and intensive care unit length of stay (odds ratio, 1.1; 95% confidence interval, 1.0-1.2; =0.002) were significantly associated with poor 2-year outcome.

CONCLUSIONS - Over one third of children experienced significant disability at 2 years. Improvements in outcomes were driven by recovery of sensorimotor function. Altered mental status, hemorrhage volume ≥4% of total brain volume, and intensive care unit length of stay were independent predictors of significant disability at 2 years.

© 2018 American Heart Association, Inc.

MeSH Terms (15)

Adolescent Brain Cerebral Hemorrhage Child Child, Preschool Female Humans Infant Infant, Newborn Male Neuroimaging Organ Size Predictive Value of Tests Prognosis Recovery of Function

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