Fellow Nicklaus Children's HOspital Nicklaus Children's Hospital Miami, Florida, United States
Background: Cerebral arteriovenous malformations (AVMs) pose a significant risk for neurological disability in children. Cerebral AVMs are an important etiology of stroke in children and seizures are a frequent comorbidity. Current data on cerebral AVMs is primarily based on single-center retrospective studies; this highlights the need for national demographic data.
Objective: The objective of this study is to describe the characteristics and short-term outcomes of pediatric cerebral AVMs.
Design/Methods: A retrospective analysis of the Kids Inpatient Database (KID) for all hospital discharges in 2009, 2012, and 2016 was performed. The database was filtered using ICD-9 diagnosis code 74781, and ICD-10 diagnosis code Q28 for patients with a diagnosis of arteriovenous malformation of cerebral vessels. Children with AVMs alone were compared to those with AVMs and seizures, using CCS diagnosis code 83 for seizures. Elective admissions were excluded from the analysis. Sample weighting was employed to produce national estimates. Chi-square, parametric, and non-parametric testing were performed using SPSS.
Results: Of the 9,181,654 discharges, 2,431 (2.6/10,000 discharges) had a non-elective admission for cerebral AVMs. The median age for patients with cerebral AVMs was 12 years of age (IQR 5 - 20); patients with cerebral AVMs and seizures had a similar age distribution. A total of 14% of patients were discharged to skilled nursing home facilities/home health care and the overall mortality was 1.3%. Intracranial hemorrhage was present in 23.5% of patients with cerebral AVMs.
Of those patients with cerebral AVMs, 897 (37.1%) had a diagnosis of seizures and 15% had status epilepticus. Craniotomy was more commonly performed in patients without seizures than those with seizures (18.4% vs 12% respectively, OR 0.6 C.I. 0.4 – 0.8). Mechanical ventilation in patients with cerebral AVMs and seizures was similar to those with cerebral AVMs alone (16.2% vs 14.2% respectively, OR 1.89, C.I. 0.93 – 1.56). There was no significant difference in mortality rate between the two groups (p=0.21). Conclusion(s): This study provides national data on the characteristics and short-term outcomes of pediatric patients with cerebral AVMs. Our cohort identifies these children as high-risk patients that require intensive medical and neurosurgical management. Seizures and intracranial hemorrhage are common in children admitted with a diagnosis of cerebral AVM.
Authors/Institutions: Juan Sebastian Proano, Nicklaus Children's Hospital, Miami, Florida, United States; Balagangadhar R. Totapally, Nicklaus Children's Hospital, Miami, Florida, United States