Background and Aims Spontaneous intracerebral hemorrhage (ICH) accounts for approximately half of stroke in childhood with an incidence around 1/100 000/year. We studied the characteristics and outcome in PICU patients with ICH.
Methods Children with ICH admitted to PICU during 2000–2010, were retrospectively studied. Clinical information was abstracted via chart review.
Results 21 consecutive cases, aged 5.6±4.5 years, 12 girls, were analyzed. 70% of the children presented with vomiting, 55% with seizures, 38% with headache and 9.6% with focal neurological signs. Mean Glasgow Coma Scale (GCS) before intubation was 7.33±2.45. In 66.6% emergent evacuation of hematoma or hydrocephalus at admission was performed. 23.5% had an arteriovenous malformation (AVM) and 15% of these children underwent embolization for AVM obliteration. Mortality was found 19%. Patients who died had lower GCS (4.75±2.06 vs. 7.9±2.16), P<0.05, higher PRISM III-12 (first 12 hours from admission), (21.5±8.1 vs. 7.8±7.7), P<0.005, higher PRISM III-24 (next 12 hours), (17.2±8.3 vs. 5.2±5.1), P<0.001, and longer αPTT, P<0.01 than those who survived. Patients who needed inotropic support the 1rst day of PICU stay had 12 times greater mortality than children who didn’t need inotropic support. Among survivors 68.7% presented neurologic deficit at PICU discharge. Children with neurologic deficit had lower GCS (6.8±1.6 vs. 10±1.5), P<0.005 than those without deficit.
Conclusions As outcome is dismal in children with ICH and critical illness at presentation, low GCS, high PRISM III and need for inotropic support, prompt diagnosis seems essential to improve prognosis in these children.