From the Vanderbilt University School of Medicine, Nashville, TN (G.S.P.).
Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania; Division of Neurocritical Care, Department of Neurosurgery (J.T.K.) and Department of Neurology (J.T.K.).
Stroke. 2018 Jul;49(7):1755-1758. doi: 10.1161/STROKEAHA.118.021845. Epub 2018 Jun 12.
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.
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.
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.
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.
脑出血是导致较高发病率和死亡率的主要原因之一。本研究通过 3 家中心合作，描述了儿科脑出血患者的结局，并识别出 2 年神经功能预后的预测因素。
2007 年 3 月至 2015 年 5 月，前瞻性纳入 29 天至 18 岁因脑出血就诊的患儿。排除标准包括创伤、颅内肿瘤、动脉缺血性卒中或脑静脉窦血栓形成的出血性转化、单纯硬膜下、硬膜外或蛛网膜下腔出血以及基线神经功能异常。在神经影像学上测量脑出血和全脑容积。采用儿科卒中结局量表（Pediatric Stroke Outcome Measure，PSOM）评估结局。
共纳入 69 例患儿（中位年龄：9.7 岁；四分位距：2.2-14 岁）。住院期间 6 例患儿（9%）死亡。98%（中位时间：3.1 个月；四分位距：3.1-3.8）的幸存者在早期随访时进行了结局评估，94%（中位时间：2.1 年；四分位距：1.3-2.8）的幸存者在晚期随访时进行了结局评估。超过三分之一的患儿在 2 年时存在显著的残疾（PSOM＞2）。PSOM 总分随时间推移逐渐改善（=0.0003），与体感运动子评分的改善一致（=0.0004）。意识状态改变（比值比，13；95%置信区间，3.9-46；＜0.001）、脑出血体积≥4%全脑容积（比值比，17；95%置信区间，1.9-156；=0.01）和重症监护病房住院时间（比值比，1.1；95%置信区间，1.0-1.2；=0.002）与 2 年不良结局显著相关。
超过三分之一的患儿在 2 年时存在显著的残疾。结局的改善是由体感运动功能的恢复驱动的。意识状态改变、脑出血体积≥4%全脑容积和重症监护病房住院时间是 2 年时显著残疾的独立预测因素。
