Jennifer Dearborn, MD
Beslow et al. recently published a prospective study of 79 children (full term infants to age 18) with ICH which examined the reliability of the author’s pediatric hemorrhage score to predict outcome at 3 months. Outcomes were measured by functional recovery 3 months after presentation with ICH, using the King’s Outcome Scale for Childhood Head Injury, or KOSCHI). The study rationale was that although such scores exist for adults, children with ICH have lower mortality than adult and thus unique prediction tools are required for the pediatric population. The elements included in the pediatric ICH score include: ICH size (adjusted for total brain volume), presence of hydrocephalus, infratentorial location, and herniation. A score greater than or equal to 2 predicted poor outcomes of death or severe disability, and a score greater than or equal to 1 predicted moderate disability or worse, both with high sensitivity and specificity.
The benefits of this score are that it is easy to use and implement. The simple scoring system, from 0 to 5, would be simple to implement in clinical practice. Although those with a higher score are more likely to have severe disability or death, the prospective validation in one population may need to be repeated in another patient group, before it can be used to counsel family members considering whether to withdraw care. As the authors point out, this may unfairly bias the poor outcomes observed in higher scores. Another question that came to mind, is would outcomes be different if we looked at children between birth and one year, and greater than one year separately? This score provides further attention to the much understudied problem of pediatric stroke, of which a large percentage is hemorrhagic. Moving forward, pediatric neurologists and intensivists have a new tool to integrate into clinical practice.