Children seem to fare better than adults following a Hemorrhagic stroke, a single-center study showed.

Of the 59 kids included in the study, 34% died within about 5 years following a hemorrhage, a rate lower than the 39% to 53% 1-year mortality rate seen in previous adult studies, according to Warren Lo, MD, of Nationwide Children’s Hospital in Columbus, Ohio, and colleagues.

Most of the survivors had mild-to-moderate neurological deficits, but they also commonly had difficulties in school or physical functioning, the researchers reported online in Archives of Neurology.

“Our results validate many findings of earlier studies and add new insights regarding the long-term outcome and quality of life following Hemorrhagic stroke in children,” they wrote.

“As the long-term outcomes of Hemorrhagic stroke become better characterized,” they continued, “physicians will be better able to recognize the range of sequelae that occur and identify the potential for long-term problems and thus be better able to help their patients.”

Previous studies have estimated that up to 45% of all strokes that occur in childhood are subarachnoid or intracerebral hemorrhages, but few studies have explored outcomes from these types of stroke in a pediatric population.

Lo and colleagues performed a retrospective case study at their center, a tertiary care pediatric hospital. They identified all 59 pediatric cases of nontraumatic subarachnoid hemorrhage with extension into the parenchyma/ventricles and intracerebral hemorrhage that were admitted between January 2000 and February 2009. They restricted the search to those ages 28 days to 18 years at the time of the stroke. The median age of the patients at the time of the event was 10.2. About one-third of the patients died following the hemorrhage. The researchers were able to contact only 19 of the 39 survivors for a follow-up assessment, which occurred a median of 5 years after the stroke. Stroke outcome was measured over the phone with the Recovery and Recurrence Questionnaire (RRQ) - which uses parental report of sensorimotor function, language production and comprehension, and cognition/behavior - and with the King’s Outcome Scale for Childhood Head Injury (KOSCHI). Quality of life was measured with the PedsQL generic scales. Most of the survivors had mild-to-moderate neurological deficits at follow-up, according to the median RRQ score. The median KOSCHI score indicated minimal impairment in daily function. Overall school functioning and physical health was impaired, as indicated by lower parent- and patient-rated quality of life scores. Hemorrhage volume - which ranged from 0.07% to 13.36% of total cerebral volume among the patients - was strongly associated with worse neurological outcomes and quality of life, although there was a threshold effect. The relationships were significant only when the hemorrhage volume was higher than 4%. Diagnoses associated with the hemorrhages - including intracranial vascular anomalies, congenital heart disease, brain or systemic malignancy, or “other” medical disorders—predicted quality of life as reported both by the parents and the children, but did not predict neurological outcomes. The roughly half of patients who had intracranial vascular anomalies had the best outcomes for all measures of quality of life, including physical health, emotional function, social function, and school function (P<0.03 for all). Those with congenital heart disease had the worst outcomes. Established predictors of outcome in adults - initial Glasgow Coma Scale score, primary location of the hemorrhage, and ventricular hemorrhage - were not associated with outcomes in the children. However, the authors wrote, "we cannot exclude that our study was underpowered to detect small differences." They acknowledged some limitations of the analysis, including the use of data from a single tertiary care children's hospital in the U.S., the inability to locate about one-quarter of the potential participants, and the reliance on telephone interviews to assess function. ### Primary source: Archives of Neurology Source reference: Lo W, et al “Outcomes in children with Hemorrhagic stroke” Arch Neurol 2012; DOI: 10.1001/jamaneurol.2013.577.