title: Subarachnoid hemorrhage prevalence and its association with short-term outcome in pediatric severe traumatic brain injury.
abstract: BACKGROUND
  Subarachnoid hemorrhage (SAH) is an independent prognostic indicator of outcome in adult severe traumatic brain injury (sTBI). There is a paucity of investigations on SAH in pediatric sTBI. The goal of this study was to determine in pediatric sTBI patients SAH prevalence, associated factors, and its relationship to short-term outcome.
  
  
  METHODS
  We retrospectively analyzed 171 sTBI patients (pre-sedation GCS ≤8 and head MAIS ≥4) who underwent CT head imaging within the first 24 h of hospital admission. Data were analyzed with both univariate and multivariate techniques.
  
  
  RESULTS
  SAH was found in 42 % of sTBI patients (n = 71/171), and it was more frequently associated with skull fractures, cerebral edema, diffuse axonal injury, contusion, and intraventricular hemorrhage (p < 0.05). Patients with SAH had higher Injury Severity Scores (p = 0.032) and a greater frequency of fixed pupil(s) on admission (p = 0.001). There were no significant differences in etiologies between sTBI patients with and without SAH. Worse disposition occurred in sTBI patients with SAH, including increased mortality (p = 0.009), increased episodes of central diabetes insipidus (p = 0.002), greater infection rates (p = 0.002), and fewer ventilator-free days (p = 0.001). In sTBI survivors, SAH was associated with increased lengths of stay (p < 0.001) and a higher level of care required on discharge (p = 0.004). Despite evidence that SAH is linked to poorer outcomes on univariate analyses, multivariate analysis failed to demonstrate an independent association between SAH and mortality (p = 0.969).
  
  
  CONCLUSIONS
  SAH was present in almost half of pediatric sTBI patients, and it was indicative of TBI severity and a higher level of care on discharge. SAH in pediatric patients was not independently associated with increased risk of mortality.
authors.affiliation: Department of Pediatrics, Western University, London, ON, Canada.
authors.forename: Elana
authors.initials: E
authors.lastname: Hochstadter
authors.forename: Tanya Charyk
authors.initials: TC
authors.lastname: Stewart
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Alharfi
authors.forename: Adrianna
authors.initials: A
authors.lastname: Ranger
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality; D002552:Cerebral Ventricles; D002648:Child; D002675:Child, Preschool; D020833:Diffuse Axonal Injury / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D020206:Subarachnoid Hemorrhage, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D014057:Tomography, X-Ray Computed