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Aug 2012

Presentations and Outcomes of Children With Intraventricular Hemorrhages After Blunt Head Trauma

Author Affiliations

Author Affiliations: Department of Pediatrics, University of Maryland School of Medicine, Baltimore (Dr Lichenstein); Department of Pediatric Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Glass); Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri (Dr Quayle); Departments of Radiology (Dr Wootton-Gorges), Surgery (Dr Wisner), Neurological Surgery (Dr Muizelaar), Emergency Medicine (Drs Holmes and Kuppermann), and Pediatrics (Dr Kuppermann), University of California–Davis School of Medicine, Davis; Department of Pediatrics, University of Utah, Salt Lake City (Ms Miskin); Department of Emergency Medicine, University of Rochester School of Medicine, Rochester, New York (Dr Badawy); and Department of Pediatrics, George Washington School of Medicine, Washington, DC (Dr Atabaki). A complete list of the individuals participating in PECARN at the time this study was initiated appears at the end of this article.

Arch Pediatr Adolesc Med. 2012;166(8):725-731. doi:10.1001/archpediatrics.2011.1919

Objective To describe the clinical presentations and outcomes of children with intraventricular hemorrhages (IVHs) after blunt head trauma (BHT).

Design Subanalysis of a large, prospective, observational cohort study performed from June 1, 2004, through September 31, 2006.

Setting Twenty-five emergency departments participating in the Pediatric Emergency Care Applied Research Network.

Patients Children presenting with IVH after BHT.

Exposure Blunt head trauma.

Main Outcome Measures Clinical presentations and outcomes, including the Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) scores at hospital discharge.

Results Of 15 907 patients evaluated with computed tomography, 1156 (7.3%) had intracranial injuries. Forty-three of the 1156 (3.7%; 95% CI, 2.7%-5.0%) had nonisolated IVHs (ie, with intracranial injuries on computed tomography), and 10 of 1156 (0.9%; 95% CI, 0.4%-1.6%) had isolated IVHs. Only 4 of 43 (9.3%) of those with nonisolated IVHs had Glasgow Coma Scale (GCS) scores of 14 to 15, and all 10 (100.0%) with isolated IVHs had GCS scores of 15. No patients with isolated IVHs required neurosurgery or died. One patient had moderate overall disability (by the POPC score), and no patient had moderate or severe disability at discharge (by the PCPC score). Of the 43 patients with nonisolated IVHs, however, 16 (37.2%) died and 18 (41.9%) required neurosurgery. In 27 patients (62.8%), injuries ranged from moderate overall disability to brain death by the POPC score.

Conclusions Children with nonisolated IVHs after BHT typically present with GCS scores of less than 14, frequently require neurosurgery, and have high mortality rates. In contrast, those with isolated IVHs typically present with normal mental status and are at low risk for acute adverse events and poor outcomes.