Subarachnoid hemorrhage prevalence and its association with short-term outcome in pediatric severe traumatic brain injury

Neurocrit Care. 2014 Dec;21(3):505-13. doi: 10.1007/s12028-014-9986-7.

Abstract

Background: Subarachnoid hemorrhage (SAH) is an independent prognostic indicator of outcome in adult severe traumatic brain injury (sTBI). There is a paucity of investigations on SAH in pediatric sTBI. The goal of this study was to determine in pediatric sTBI patients SAH prevalence, associated factors, and its relationship to short-term outcome.

Methods: We retrospectively analyzed 171 sTBI patients (pre-sedation GCS ≤8 and head MAIS ≥4) who underwent CT head imaging within the first 24 h of hospital admission. Data were analyzed with both univariate and multivariate techniques.

Results: SAH was found in 42 % of sTBI patients (n = 71/171), and it was more frequently associated with skull fractures, cerebral edema, diffuse axonal injury, contusion, and intraventricular hemorrhage (p < 0.05). Patients with SAH had higher Injury Severity Scores (p = 0.032) and a greater frequency of fixed pupil(s) on admission (p = 0.001). There were no significant differences in etiologies between sTBI patients with and without SAH. Worse disposition occurred in sTBI patients with SAH, including increased mortality (p = 0.009), increased episodes of central diabetes insipidus (p = 0.002), greater infection rates (p = 0.002), and fewer ventilator-free days (p = 0.001). In sTBI survivors, SAH was associated with increased lengths of stay (p < 0.001) and a higher level of care required on discharge (p = 0.004). Despite evidence that SAH is linked to poorer outcomes on univariate analyses, multivariate analysis failed to demonstrate an independent association between SAH and mortality (p = 0.969).

Conclusion: SAH was present in almost half of pediatric sTBI patients, and it was indicative of TBI severity and a higher level of care on discharge. SAH in pediatric patients was not independently associated with increased risk of mortality.

MeSH terms

  • Adolescent
  • Brain Injuries / complications*
  • Brain Injuries / diagnostic imaging
  • Brain Injuries / mortality
  • Cerebral Hemorrhage / complications
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / mortality
  • Cerebral Ventricles
  • Child
  • Child, Preschool
  • Diffuse Axonal Injury / complications*
  • Diffuse Axonal Injury / diagnostic imaging
  • Diffuse Axonal Injury / mortality
  • Female
  • Hospital Mortality*
  • Humans
  • Intensive Care Units, Pediatric / statistics & numerical data*
  • Length of Stay / statistics & numerical data*
  • Male
  • Prognosis
  • Retrospective Studies
  • Skull Fractures / complications*
  • Skull Fractures / diagnostic imaging
  • Skull Fractures / mortality
  • Subarachnoid Hemorrhage, Traumatic / complications*
  • Subarachnoid Hemorrhage, Traumatic / diagnostic imaging
  • Subarachnoid Hemorrhage, Traumatic / mortality
  • Tomography, X-Ray Computed