Introduction: The evidence base for pediatric subarachnoid hemorrhage is sparse. Despite recent debates over treatment choices and time to treatment, little is know about how these factors impact pediatric outcomes. We evaluated the relationships between perioperative outcomes and a variety of surgeon-dependent and -independent factors for children with subarachnoid hemorrhage.
Methods: We selected a cohort of pediatric patients with subarachnoid hemorrhage from the Nationwide Inpatient Sample who underwent clipping or coiling. Primary outcomes were mortality, complication, routine discharge, and length of stay. These were analyzed with multivariate regression to assess for associations with demographic and clinical variables.
Results: We identified 101 pediatric patients with subarachnoid hemorrhage that were treated with coiling (n=51) or clipping (n=50). Illness severity score was most strongly associated with complications (OR 0.01, p=0.013, for score of 3 vs. 4). Although patients who underwent clipping were found to have more complications (OR 3.44, p=0.027), the rates of mortality, routine discharge to home, and length of stay were not significantly different. Length of stay was strongly associated with ventriculostomy placement (28.4 vs 18.2 days, p=0.018) as well as worse initial severity score (31.8 vs. 17.6 days, p=0.036). We further analyzed these outcomes as a function of time to treatment, but only found significant association with length of stay (16.9 vs. 24.5 days, p=0.023).
Conclusions: Pediatric subarachnoid patients have relatively low mortality rates despite high rates of complications. Clipping and coiling were equally represented, but this choice had little impact on outcome. Furthermore, time to treatment was not associated with any functional outcomes. Our analysis suggests that the severity of the patient’s initial presentation is the single factor most highly correlated with outcomes, which also correlates with ventriculostomy placement. Thus, surgeon-related factors are secondary to those of the primary disease process in determining pediatric subarachnoid outcomes.
Patient Care: This research demonstrates that choice of surgical versus endovascular intervention and time to treatment are not significantly associated with patient outcomes in subarachnoid hemorrhage.
Learning Objectives: To describe surgeon-dependent and independent factors relating to outcome in pediatric subarachnoid hemorrhage