Pediatric Endovascularly Treated Aneurysmal Subarachnoid Hemorrhage: A Twenty-Year National Inpatient Sample Study of Morbidity and Mortality.

INTRODUCTION

Aneurysmal subarachnoid hemorrhage (aSAH) in pediatric patients is a rare but severe disease associated with significant morbidity and mortality. While endovascular treatment is widely used in adult aSAH, its utilization and outcomes in pediatric patients remain underexplored.

METHODS

This retrospective cohort study used the National Inpatient Sample (NIS) to identify pediatric patients (<18 years) who underwent endovascular treatment for aSAH from 2000 to 2020. Outcomes analyzed included in-hospital mortality, nonhome discharge, length of stay, overall hospital course complications, and inflation-adjusted cost of care. Multivariable regression models assessed predictors of outcomes and healthcare resource utilization.

RESULTS

Throughout the study period, 1,923 pediatric patients underwent endovascular aSAH therapy from 2000 to 2020. The mean age was 11.9 ± 5.2 years. The overall in-hospital mortality rate was 4.1%, and 40.6% of patients required nonhome discharge. Complications at any point in hospitalization were frequent (67.7%), with pulmonary complications (64.3%) being the most common, followed by deep vein thrombosis (13.0%) and thromboembolic events (12.4%). Sepsis occurred significantly more often in boys than girls (13.2% vs. 1.6%, p = 0.011). Mean hospitalization cost was USD 108,442.93 ± USD 95,971.98. Racial disparities in morbidity and mortality were slim. The National Inpatient Sample Subarachnoid Hemorrhage Severity Score (NIS-SSS) was a significant predictor of nonhome discharge (adjusted odds ratio [aOR] 1.28, p = 0.0049) and adverse hospital course events (aOR 1.94, p = 0.0036). The South (p = 0.0029) and West (p = 0.0008) patients were significantly less likely to experience nonhome discharge than those in the Northeast.

CONCLUSION

Endovascular therapy for pediatric aSAH has increased significantly over 2 decades, with stable hospital course complication rates and relatively low in-hospital mortality. The NIS-SSS score predicts nonhome discharge and adverse hospital course events, supporting its role in pediatric risk stratification. Despite regional differences in discharge patterns, care appears equitable across demographic and socioeconomic groups.