Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma

Richard Lichenstein, Todd F. Glass, Kimberly S. Quayle, Sandra L. Wootton-Gorges, David H Wisner, Michelle Miskin, Jan Paul Muizelaar, Mohamed Badawy, Shireen Atabaki, James F Holmes Jr, Nathan Kuppermann

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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. Fortythree 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.

Original languageEnglish (US)
Pages (from-to)725-731
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Volume166
Issue number8
DOIs
StatePublished - Aug 2012

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Craniocerebral Trauma
Hemorrhage
Pediatrics
Glasgow Coma Scale
Neurosurgery
Wounds and Injuries
Tomography
Brain Death
Emergency Medical Services
Observational Studies
Hospital Emergency Service
Cohort Studies
Outcome Assessment (Health Care)
Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma. / Lichenstein, Richard; Glass, Todd F.; Quayle, Kimberly S.; Wootton-Gorges, Sandra L.; Wisner, David H; Miskin, Michelle; Muizelaar, Jan Paul; Badawy, Mohamed; Atabaki, Shireen; Holmes Jr, James F; Kuppermann, Nathan.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 166, No. 8, 08.2012, p. 725-731.

Research output: Contribution to journalArticle

Lichenstein, Richard ; Glass, Todd F. ; Quayle, Kimberly S. ; Wootton-Gorges, Sandra L. ; Wisner, David H ; Miskin, Michelle ; Muizelaar, Jan Paul ; Badawy, Mohamed ; Atabaki, Shireen ; Holmes Jr, James F ; Kuppermann, Nathan. / Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma. In: Archives of Pediatrics and Adolescent Medicine. 2012 ; Vol. 166, No. 8. pp. 725-731.
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abstract = "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. Fortythree 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.",
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AU - Wisner, David H

AU - Miskin, Michelle

AU - Muizelaar, Jan Paul

AU - Badawy, Mohamed

AU - Atabaki, Shireen

AU - Holmes Jr, James F

AU - Kuppermann, Nathan

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N2 - 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. Fortythree 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.

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