# Etiology and early clinical predictors of neurological outcomes in pediatric spontaneous intracranial hemorrhage: a retrospective exploratory study

## TL;DR

This study explores the causes and early signs that predict neurological outcomes in children with spontaneous brain bleeds.

## Contribution

The study identifies seizures at onset and secondary causes like infections as strong predictors of poor recovery in pediatric brain hemorrhage.

## Key findings

- Vascular and unknown causes were the most common etiologies of pediatric sICH.
- Seizures at onset and secondary etiologies like infections significantly increase the risk of poor neurological outcomes.
- Vomiting and higher GCS scores are associated with better recovery in children with sICH.

## Abstract

Pediatric spontaneous intracranial hemorrhage (sICH) is rare but clinically diverse, and prognostic evaluation remains challenging because current models rely mainly on anatomical severity rather than etiologic or early clinical features. This study aimed to characterize the etiologic spectrum of pediatric sICH and identify early predictors of 3-month neurological outcomes.

This retrospective study included children aged 1 month to 14 years diagnosed with sICH at Hebei Children’s Hospital from December 2016 to December 2024. Patients were divided into four etiologic groups: unknown causes, vascular causes, blood-related causes, and other defined causes. Clinical, radiologic, and laboratory data at admission were collected. Neurological outcomes were assessed using the modified Rankin Scale (mRS) at 3 months, with poor outcome defined as mRS > 2. Variables significant in univariate analyses (p < 0.1) were entered into multivariate logistic regression to identify independent predictors of poor outcome.

Among 148 children (median age 48.0 months; 39.2% female), vascular (35.1%) and unknown etiologies (33.8%) were most common. Poor outcomes occurred in 58 patients (39.2%). In multivariate analysis, seizures at onset (OR = 2.861, 95% CI: 1.076–7.612, p = 0.035) and other defined etiologies—including infections, tumors, and systemic diseases—were strong independent predictors of poor recovery (OR = 8.025, 95% CI: 1.606–40.112, p = 0.011). Vomiting at presentation emerged as a novel protective factor (OR = 0.292, 95% CI: 0.112–0.763, p = 0.012); these findings were exploratory and require further validation. Higher admission Glasgow Coma Scale (GCS) scores were also protective (OR = 0.795, 95% CI: 0.667–0.946, p = 0.010).

The etiologic distribution of pediatric sICH is markedly diverse, and the prognosis at 3 months is substantially influenced by both etiology and early clinical characteristics. Seizures at onset and secondary etiologies (such as infections and tumors) significantly increase the risk of poor outcome, whereas vomiting and higher GCS scores are associated with more favorable recovery. Early integration of etiologic classification and clinical presentation may enhance prognostic accuracy and guide individualized management strategies in pediatric sICH.