Abstract TP19: Predictors of Outcome in Subarachnoid Hemorrhage in the Pediatric Population

Abstract

Background: Studies describing outcomes of subarachnoid hemorrhage (SAH) in children are sparse. This study aims to describe outcomes and determinants of outcomes in pediatric patients with SAH. Methods: We reviewed all pediatric admissions with the primary diagnosis of SAH from the 2016-2020 National Inpatient Sample using International Classification of Disease Codes. Baseline characteristics of patients (age, gender, and associated comorbidities) were computed using descriptive statistics. Multivariable-adjusted logistic regression determined predictors of in-hospital mortality for children with SAH. Results: 1,310 weighted hospitalizations for SAH were identified during the 5-year study period. The median age was 11.8 years (95% CI, 11.0-12.5), 54.6% were male. Seizures (34.6%), intraparenchymal hematoma (21.7%), acute ischemic stroke (6.4%), brain tumors (0.7%), and arteriovenous (AV) malformations (6.1%) were identified as the most common associated neurologic disorders during index hospitalization. 320 patients (24.4%) were treated endovascularly and 480 (36.6%) were treated via open surgical approach to treat vascular pathologies (AV malformations, dural AV fistulas, and aneurysms). Median length of hospitalization was 9.7 days (95% CI, 8.2-11.2. A total of 61.8% were discharged home, 29.3% were discharged to a rehabilitation facility, and in-hospital mortality was 8.8%. Patient-level variables associated with higher odds of mortality were age (Odds Ratio [OR] 1.01, [95% CI 1.01-1.02], p<0.001), higher NIS-Subarachnoid Hemorrhage Severity Score (NIS-SSS) (12.64 [4.21-37.95], p<0.001), coagulopathy (5.72, [1.40-23.29], p=0.01), and liver dysfunction (69.02 [2.65 - >999], p=0.01). Conclusion: Six of ten pediatric patients with SAH are discharged with excellent outcome with a 10% index hospitalization mortality. Underlying coagulopathy and liver dysfunction are the strongest risk factors for mortality