Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis

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  • 1 Service d’imagerie Morphologique et Fonctionnelle, GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, INSERM, Université de Paris;
  • | 2 Departments of Pediatric Radiology,
  • | 3 Pediatric Neurosurgery,
  • | 4 Pediatric Neurology,
  • | 5 Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de référence Malformations Cardiaques Congénitales Complexes–M3C,
  • | 6 INSERM UMR1163, Imagine Institute, Data Science Platform,
  • | 7 Pediatric Neuro-ICU, and
  • | 8 Hematology, Haemophilia Care Centre, Hôpital Necker Enfants Malades, AP-HP, Université de Paris;
  • | 9 INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, and INSERM U1000; and
  • | 10 French Center for Pediatric Stroke, Paris, France
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OBJECTIVE

The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH.

METHODS

Children who received treatment for pICH at the authors’ institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes.

RESULTS

Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6–12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13–63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%–36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%–57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%–24%; Q = 101.6; I2 = 81%).

CONCLUSIONS

Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.

ABBREVIATIONS

ICH = intracerebral hemorrhage; KOSCHI = King’s Outcome Scale for Childhood Head Injury; MOOSE = Meta-Analysis of Observational Studies in Epidemiology; pICH = pediatric intracerebral hemorrhage.

Supplementary Materials

    • Supplemental Figures and Tables (PDF 1158 kb)

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Contributor Notes

Correspondence Grégoire Boulouis: CH Sainte Anne, GHU Paris, France. gregoireboulouis@gmail.com.

INCLUDE WHEN CITING Published online April 9, 2021; DOI: 10.3171/2020.9.PEDS20608.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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