Children recovering from hemorrhagic stroke are more likely to have better recovery outcomes if they had a low hemorrhage-brain ratio or certain underlying diagnoses.
LOS ANGELES—In children with hemorrhagic stroke, underlying diagnosis and hemorrhage-brain ratio are better predictors of long-term outcome than ventricular involvement, hemorrhage location, or Glasgow Coma Scale (GCS) score, according to research presented at the 2011 International Stroke Conference.
Christine Hajek, a graduate student at Ohio State University and the Nationwide Children’s Hospital in Columbus, Ohio, and colleagues analyzed the medical records of children who had a hemorrhagic stroke to determine which factors best predicted neurologic and quality-of-life outcomes.
Of the 59 children eligible for the study, 19 (median age, 10.17) were contacted by telephone and were included in the analysis. The investigators recorded patients’ GCS score and underlying diagnosis and analyzed MRI scans to determine hemorrhage location, volume, and ventricular involvement.
“GCS, hemorrhage location, and ventricular involvement did not predict outcomes,” Ms. Hajek and colleagues reported. A hemorrhage-brain ratio greater than or equal to 4% was the only predictor associated with lower scores on all assessments, including the Recovery and Recurrence Questionnaire, the King’s Outcome Scale for Children, and the Pediatric Quality of Life Scale.
Underlying diagnosis was also a predictor of outcome, but diagnosis was significant in predicting lower scores on only two of the four assessments. “Diagnostic categories were only significantly associated with poorer quality-of-life outcomes,” the investigators wrote. “However, analyses suggest that children with intracranial vascular anomalies tended to rate quality of life as slightly higher compared to children with other diagnoses.
“In the adult literature, GCS, underlying diagnosis, ventricular involvement, and lesion location are associated with outcome following stroke,” the authors wrote. “We did not observe that they did so in our sample of children.
“Hemorrhagic stroke in children behaves differently from that in adults,” the researchers stated, adding that the topic needs further exploration.
“Our results support previous findings that a hemorrhage-brain ratio greater than or equal to 4% is significantly associated with a poorer outcome,” the investigators concluded. “The underlying cause is an important factor in the long-term quality of life.”