{
  "abstract": "Introduction Pediatric aneurysmal subarachnoid hemorrhage (aSAH) is rare yet presents with significant morbidity and complications. Adult clinical trials indicate various benefits of surgical and endovascular treatment. However, literature regarding pediatric aSAH intervention-based outcomes limited.Methods We performed a retrospective cohort study utilizing the Kids’ Inpatient Database (KID) - the largest all-payer pediatric inpatient database in the US. Cohorts were based on craniotomy or endovascular therapy. The primary outcome of this study was in-hospital mortality. Secondary outcomes included length of stay, re-operation, vasospasm, discharge disposition, procedural complications, and hospital costs.Results Of 376 aSAH pediatric patients, 63.6% underwent endovascular therapy. ACOM (Cr: 15.3% vs. E: 7.9%, p = 0.039) and PCOM (Cr: 16.8% vs. E: 11.7%, p = 0.020) aneurysms were more common in patients who underwent craniotomy. Patients who underwent craniotomy had higher baseline NIS-Subarachnoid Severity Score (NIS-SSS) scores (Cr: 3.12 vs. E: 2.02, p = 0.002) and higher rates of in-hospital coma (Cr: 18.2% vs. E: 9.6%, p = 0.024). Rates of in-hospital mortality, favorable discharge, and procedural complications were similar between groups. Length of stay (Cr: 20.8 vs. E: 12.6, p <0.001), re-operation rates (Cr: 17.5% vs. E: 7.1%, p = 0.003), rates of cerebral vasospasm (Cr: 27.7% vs. E: 18.4%, p = 0.048), and hospital costs (Cr: $192, 896 vs. E: $169, 286, p = 0.013) were higher in the craniotomy group.In multivariate analysis,endovascular therapy was independently associated with decreased odds of re-operation (AOR 0.29, p = 0.003).Conclusion In a nationally representative sample of pediatric patients hospitalized with aSAH, craniotomy for aneurysm clipping and endovascular embolization were comparable in terms of in-hospital mortality, favorable discharge, and procedural complications. Endovascular therapy was associated with reduced length of stay, re-operation rates, cerebral vasospasm rates, and hospital costs. While these findings suggest endovascular therapy may offer some in-hospital advantages, differences in baseline symptom severity, aneurysm location, and presence of space occupying hematoma should be considered.Disclosures M. Rashad: None. P. Reddi: None. K. John: None. T. Surtees: None. N. Marupudi: None.Abstract O-030 Table 1Pediatric aSAH baseline characteristics and in-hospital diagnosis and proceduresVariable UnmatchedTotal CohortCraniotomyEndovascularpSMDn376137239Female (N, %)180 (%)68 (49.6%)112 (46.9%)0.6810.06Age (mean (SD))14.20 (5.80)14.81 (5.45)13.85 (5.98)0.1130.169Region (N, %)Midwest74 (19.7%)24 (17.5%)50 (20.9%)0.5070.09Northeast75 (19.9%)17 (12.4%)58 (24.3%)0.0080.31South142(37.8%)55 (40.1%)87 (36.4%)0.5420.08West85 (22.6%)41 (29.9%)44 (18.4%)0.0150.27Race (N, %)Asian19 (5.1%)4 (2.9%)15 (6.3%)0.2230.16Black84 (22.3%)27 (19.7%)57 (23.8%)0.5630.08Hispanic80 (21.3%)32 (23.4%)48 (20.1%)0.3960.11Native American2 (0.5%)1 (0.7%)1 (0.4%)10.04Other22 (5.9%)4 (2.9%)18 (7.5%)0.1070.20White152(40.4%)59 (43.1%)93 (38.9%)0.2910.13Median Household Income (N, %)0-25th Percentile114(30.3%)33 (24.1%)81 (33.9%)0.0640.2226th-50th Percentile76 (20.2%)30 (21.9%)46 (19.2%)0.6110.0751st-75th Percentile101 (26.9%)39 (28.5%)62 (25.9%)0.6580.0676th-100th Percentile78 (20.7%)32 (23.4%)46 (19.2%)0.4000.10Aneurysm Location (N, %)ICAACOMMCAPCOM6 (1.6%)40 (10.6%)51 (13.6%)25 (6.6%)3 (2.2%)21 (15.3%)23 (16.8%)15 (10.9%)3 (1.3%)19 (7.9%)28 (11.7%)10 (4.2%).672.039.220.020.07.23.15.26Coma (N, %)48 (12.8%)25 (18.2%)23 (9.6%).0240.25Ventilator (N, %)6 (1.6%)3 (2.2%)3 (1.3%)0.6720.07Seizure (N, %)84 (22.3%)33 (24.1%)51 (21.3%)0.6260.07Prothrombotic Disorder (N, %)9 (2.4%)1 (0.7%)8 (3.3%)0.1640.19Stroke (N, %)30 (8.0%)10 (7.3%)20 (8.4%)0.8650.04Meningitis (N, %)4 (1.1%)1 (0.7%)3 (1.3%)10.05Hydrocephalus (N, %)101(28.7%)39 (28.5%)69 (28.9%)10.01Deep Vein Thrombosis (N, %)2 (0.5%)0 (0.0%)2 (0.8%)0.5360.13External Ventricular Drain (N, %)106 (28.2%)41 (29.9%)65 (27.2%)0.6550.06Tracheostomy (N, %)17 (4.5%)10 (7.3%)7 (2.9%)0.090.20Peg/G-tube (N, %)14 (3.7%)8 (5.8%)6 (2.5%)0.1750.17Ventricular Shunt (N, %)21 (5.6%)10 (7.3%)11 (4.6%)0.3880.11NIS-SSS (mean (SD))2.42 (3.11)3.12 (3.34)2.02 (2.91)0.0020.350Abstract O-030 Table 2Pediatric aSAH in-hospital outcomesTotal CohortCraniotomyEndovascularpSMDIn-hospital Mortality (N, %)13 (3.5%)5 (3.6%)8 (3.3%)10.02Discharge Home or Short-term hospital (N, %)278 (73.9%)97 (70.8%)181 (75.7%)0.3550.11Length of Stay (mean (SD))14.00 (19.11)16.38(20.83)12.64 (17.94)0.0000.193Re-operation rates (N, %)41 (10.9%)24 (17.5%)17 (7.1%)0.0030.32Intra-operative/post-procedural complications (N, %)6 (1.6%)3 (2.2%)3 (1.3%)0.6720.07Cerebral vasospasm (N, %)82 (21.8%)38 (27.7%)44 (18.4%)0.0480.22Hospital Costs (mean (SD))$177,889 ($221,416)$192, 896 ($231,297)$169,286 ($91,929)0.0130.11Abstract O-030 Table 3Multivariate analysis of aSAH in-hospital outcomes controlling for the covariates NIS-SSS, ACOM aneurysm location, and PCOM aneurysm locationOutcomeAOR or β coefficient[95% Conf. Int.]p-valueRe-operation rates0.39 (AOR)[0.20 to 0.77]0.007Length of Stay (days)-0.70 (β)[-4.47 to 3.07]0.715Vasospasm rates1.16 (AOR)[0.57 to 2.39]0.683Hospital Cost ($)$11,739 (β)[$-32,427 to $55,906]0.602",
  "authors": [
    {
      "affiliations": [
        "University of Michigan, Ann Arbor, MI"
      ],
      "name": "M Rashad"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Michigan, Ann Arbor, MI"
      ],
      "name": "P Reddi"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Michigan, Ann Arbor, MI"
      ],
      "name": "K John"
    },
    {
      "affiliations": [
        "University of Michigan, Ann Arbor, MI"
      ],
      "name": "S Koduri"
    },
    {
      "affiliations": [
        "Radiology, University of Michigan Health System, Ann Abor, MI"
      ],
      "name": "Z Wilseck"
    },
    {
      "affiliations": [
        "Neurology, University of Michigan, Ann Arbor, MI"
      ],
      "name": "T Surtees"
    },
    {
      "affiliations": [
        "University of Michigan, Ann Arbor, MI"
      ],
      "name": "A Pandey"
    },
    {
      "affiliations": [
        "Radiology, University of Michigan Health System, Ann Arbor, MI"
      ],
      "name": "N Chaudhary"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Michigan, Ann Arbor, MI"
      ],
      "name": "N Marupudi"
    }
  ],
  "title": "O-030 Pediatric aSAH management strategies: insights from a national inpatient sample analysis",
  "uid": "124cdbd7-0b11-595b-a4d1-64211dc1b1a5"
}