Itai Bezherano
Jacob's School of Medicine and Biomedical Sciences
Buffalo, NY
Disclosure information not submitted.
Mohammad Haider, MD, PhD
Associate Director of Research
University at Buffalo Concussion Management Clinic and Research Center, United States
Disclosure information not submitted.
Olumayowa Adebiyi, BA, MS
Medical Student
Jacob's School of Medicine and Biomedical Sciences, United States
Disclosure information not submitted.
Carolina Ungs, MD
Resident
Jacobs School of Medicine and Biomedical Sciences, United States
Disclosure information not submitted.
Justin Assioun, MD
Resident
Jacobs School of Medicine and Biomedical Sciences, United States
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Renee Reynolds, MD
Dr.
Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA, United States
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Kathryn Bass, MD, MBA
Director, Level 1 Pediatric Trauma Center
Oishei Children's Hospital, Buffalo NY, United States
Disclosure information not submitted.
Crystal Gifford, BS, RN
Nurse
Oishei Children's Hospital, Buffalo NY, United States
Disclosure information not submitted.
Anil Swayampakula, MD MPH
Attending Physician
Oishei Children's Hospital, Buffalo NY, United States
Disclosure information not submitted.
Title: Outcomes of Hemorrhagic Intracranial Lesions in Pediatric Patients Secondary to Trauma
Introduction: Data describing the outcomes of various traumatic intracranial hemorrhages (ICH) in children is limited. In this study, we describe types of ICH and their outcomes. We also intend to assess the differences between accidental (AT) and non-accidental trauma (NAT).
Methods: We conducted a retrospective study at a level 1 trauma center in patients < 18 year (n=202) between 01/2014 and 03/2021 with a traumatic ICH. Data collected included demographics, type of ICH, initial presentation, neuroimaging findings, injury severity score (ISS), and presence of confirmed NAT. Outcomes included ICU/hospital length of stay (LOS) in days (d), and patient disposition. Comparative statistics were performed between hemorrhage type and AT/NAT.
Results: Mean age was 5.6 years. 11 patients died (5.4%). Patients were grouped into epidural hematoma (EDH n=35), subdural hematoma (SDH n=98), intraparenchymal hemorrhage (IPH n=15), subarachnoid hemorrhage (SAH n=29), and mixed lesions (MIX n=25). Patients with EDH were more likely to have a skull fracture (P < .01) and higher ISS compared to other isolated lesions (p < .01). Despite this, EDH group had the shortest ICU (3.5 ± 3.7d; p< .01), hospital (4.9 ± 5.6d; p=.01) LOS, and highest rate of disposition to home (97%). Patients with SDH were younger (48.0 ± 64.0 months) and presented with loss of consciousness more often. This group had the highest rate of confirmed NAT (p < .01) and disposition to foster care (p < .01). SAH group had the lowest ISS score (14.5 ± 11.0); no differences in outcomes were noted compared to other groups. There were no statistically significant differences between IPH group outcomes and others. The MIX group had the longest hospital (25.4 ± 41.6 d) and ICU (12.1 ± 13.4d) LOS. Secondary analysis showed 58 patients in the NAT and 144 in the AT groups. NAT patients were younger (18.1 ± 37.0 vs 87.6 ± 69.0 months; p< .01) and more likely presented with an isolated SDH (74% vs 39%; p< .01). More often, patients in AT had penetrating head injury (18% vs 1%; p< .01), skull fracture (61% vs 27%; p< .01) and shorter hospital LOS (8.3 ± 11.3 vs 17.8 ± 27.9; p< .01).
Conclusion: Patients with EDH had better outcomes despite high initial ISS; patients in the MIX group had the worst outcomes. Patients with NAT had higher incidence of SDH and worse outcomes than AT.