24: Subarachnoid Hemorrhage is not Independently Associated with Mortality in Pediatric Severe Traumatic Brain Injury

Abstract

Subarachnoid hemorrhage (SAH) is an independent prognostic indicator of outcome in adult patients who have suffered a severe traumatic brain injury (sTBI). There is a paucity of investigations on SAH in pediatric sTBI. The goal of this study was to determine SAH incidence, associated factors and its relationship to outcome in pediatric sTBI patients. Included were 171 sTBI patients (pre-sedation GCS ≤8 and head MAIS ≥4) who underwent CT head imaging within the first 24 h of hospital admission We found that 42% of sTBI patients had SAH (n=71 of 171), and that SAH was more frequently associated with 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 a strong relationship between SAH and sTBI outcome on univariate analysis, multivariate analysis failed to demonstrate that SAH had an independent association with mortality (P=0.969). In conclusion, SAH was a frequent head imaging abnormality in almost half of pediatric sTBI patients and it appeared to be indicative of more severe TBI. As opposed to adult sTBI, SAH in pediatric patients was not independently associated with increased risk of mortality.