Introduction: Aneurysmal subarachnoid hemorrhage is rarer in children compared to adults, and few studies have examined treatment outcomes. Recent studies suggest that early treatment of ruptured aneurysms in adults improves outcomes. In this study, we evaluate the relationship between time-to-treatment and outcomes in the pediatric population and identify outcome predictors.
Methods: We identified a cohort of pediatric patients that underwent clipping and/or coiling for ruptured aneurysm from the Nationwide Inpatient Sample (1998 to 2009). We used multivariate logistic regression and analysis of covariance to evaluate the relationship of time to treatment with outcomes and to identify independent predictors of outcome. Primary outcomes included mortality, complication, routine discharge, and length of stay. Covariates of interest included demographic and baseline clinical variables and time to treatment.
Results: 168 pediatric patients had aneurysms treated by clipping and/or coiling, 100 of which were ruptured. Perioperative mortality was 2.4% (4/168) and the complication rate was 35.7% (60/168). Early intervention conferred a significant advantage in complications (p=0.001) and mortality (p=0.026). The median length of stay was 10 days, and 77.5% had a routine discharge. Although there was no difference in odds of routine discharge (p=0.46), early treatment independently predicted shorter median length of hospital stay (8 vs. 15 days, p<0.001) and less hospital charges ($120,280 vs. $193,082, p=0.003). Patients with multiple comorbidities were more likely to have complications (p<0.0001) and longer length of stay (p<0.0001). Age <10 years independently predicted higher odds of routine discharge (p=0.0001). The need for an external ventricular drain was associated with longer length of stay (p<0.0001) and reduced routine discharge (p=0.0001).
Conclusions: Time to treatment significantly impacts morbidity and mortality and is associated with shorter hospital stay and lower hospital charges. Baseline medical and demographic variables may play a large role in outcome.
Patient Care: Influence understanding of how practice patterns can influence outcomes in the treatment of pediatric aneurysm
Learning Objectives: By the end of the session, participants should be albe to understand prognostic and treatment-related factors impacting outcomes in pediatric aneurysm treatment.