Intraventricular Hemorrhage After Blunt Head Trauma in Children

Children with isolated intraventricular hemorrhage had better outcomes than children with additional intracranial injuries.

In a subanalysis of a study of approximately 16,000 children <18 years of age who presented to 25 emergency departments with blunt head trauma and underwent head computed tomography (CT), investigators compared clinical presentations and outcomes between those with isolated and those with nonisolated intraventricular hemorrhage. Nonisolated intraventricular hemorrhage was defined as an intraventricular hemorrhage associated with at least one of the following features: intracranial hemorrhage or contusion, cerebral edema, traumatic infarction, diffuse axonal injury, shearing injury, sigmoid sinus thrombosis, midline shift or signs of brain herniation, skull diastasis, pneumocephalus, or depressed skull fracture.

Of 1156 children (7.3%) with intracranial injuries identified on CT, 53 (4.6%) had intraventricular hemorrhage, which was isolated in 10. Children with isolated hemorrhage were more likely to have Glasgow Coma Scale scores of 14 or 15 than those with nonisolated hemorrhage (100% vs. 9%); scores were 3 to 8 in 72% of children with nonisolated hemorrhage. Patients with nonisolated hemorrhage experienced the following adverse events: death from traumatic brain injury (37%), neurosurgical intervention (42%), and intubation for >24 hours (56%); no patients with isolated hemorrhage had adverse events. At hospital discharge, more than half of the children with nonisolated hemorrhage either died or had moderate to severe disability, whereas no patient with isolated hemorrhage died and one had moderate disability.

CITATION(S):

Lichenstein R et al. Presentations and outcomes of children with intraventricular hemorrhages after blunt head trauma. Arch Pediatr Adolesc Med 2012 Aug; 166:725.