Predictors of recovery from intracerebral hemorrhage in children

儿童脑出血康复的预测因素

• 批准号: 7557879
• 负责人: Lori Chaffin Jordan
• 金额: $ 17.7万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7557879
• 关键词: Acute; Adult; Affect; Age; American Heart Association; Blood Pressure; Brain hemorrhage; Cause of Death; Cerebral hemisphere hemorrhage; Cerebrum; Cessation of life; Child; Childhood; Childhood stroke; Clinical; Data; Enrollment; Etiology; Exhibits; Failure; Foundations; Future; Glasgow Outcome Scale; Goals; Guidelines; Hemorrhage; Homeostasis; Hospitals; Hour; Impairment; Intervention; Intracranial Pressure; Joints; Jordan; Lead; Life; Location; Longitudinal Studies; Measures; Medical center; Near-Infrared Spectroscopy; Neurologic; Neurologic Deficit; Neurological outcome; Outcome; Outcome Measure; Patient Care; Patients; Publishing; Quality of life; Recovery; Recruitment Activity; Research; Research Personnel; Risk; Risk Factors; Scientist; Severities; Site; Stroke; Surgical Blood Loss; Symptoms; Therapeutic Intervention; Time; Traumatic cerebral hemorrhage; Work; base; cerebrovascular; cohort; disability; indexing; instrument; intraventricular hemorrhage; loris; mortality; novel; outcome forecast; pressure; prognostic; programs; prospective; public health relevance; treatment trial

DESCRIPTION (provided by applicant): Stroke is among the top ten causes of death in children. Hemorrhagic stroke represents 50% of strokes and two-thirds of the mortality in childhood. The most common form of hemorrhagic stroke is spontaneous (non-traumatic) intracerebral hemorrhage (ICH). ICH in children has been vastly understudied and potential therapies in adults may not be applicable to children. Before interventional trials and prognostic studies can be undertaken, it is essential to first determine the clinical and pathophysiological factors that affect outcome. In preliminary research by the applicant, odds of death after ICH increased 1.85 times (95% 01:1.07-3.20) per additional 10cc of hemorrhage volume when adjusted for age. ICH locations that were associated poor outcome included the 4th ventricle and the frontotemporal regions. Based on preliminary data, we propose to do the following: Aim 1 is to conduct a prospective longitudinal study of ICH in children to assess time to presentation, etiology, hemorrhage size and other potential predictors of outcome. Hypotheses: 1) Outcome will be worse in children who have larger hemorrhages and in those who have intraventricular hemorrhage, 2) hemorrhage location in patients with poor neurological outcome will be distinct from hemorrhage location in those with good neurological outcome, 3) hemorrhage size and location will be independent predictors of outcome. Therefore, scores for both will be important for creating a formula that predicts outcome. Aim 2 is to determine if measures of intracranial pressure (ICP) and cerebral autoregulation also predict outcome after childhood ICH. A novel indicator of cerebral autoregulation, the cerebral oxygenation index (COx) will be evaluated. COx is measured non-invasively by near infrared spectroscopy (NIRS) and arterial blood pressure. Hypotheses: 1) Children who exhibit failure of cerebral autoregulation as defined as COx >0.3 in the first 24 hours after ICH will have a worse outcome after ICH at 3 and 12 months. The COx may provide a non-invasive measure of cerebral autoregulation that could be used for patient management. Public Health Relevance: This study will provide a better understanding of the factors that predict neurological outcome after childhood ICH, an important cause of mortality and life-long disability in children, and will lay a foundation for future advances in patient care including treatment trials.

描述（由申请人提供）：中风是儿童死亡的十大原因之一。出血性中风占儿童死亡率的50％和三分之二。出血性中风的最常见形式是自发（非创伤）脑出血（ICH）。儿童中的ICH已被大量研究，成人的潜在疗法可能不适用于儿童。在进行介入试验和预后研究之前，首先确定影响预后的临床和病理生理因素至关重要。在申请人的初步研究中，ICH后的死亡率增加了1.85倍（95％01：1.07-3.20），每增加10cc的出血体积，并在调整年龄时增加。相关结果不佳的ICH位置包括第四脑室和额颞区。基于初步数据，我们建议做以下操作：目标1是对儿童的ICH进行前瞻性纵向研究，以评估表现的时间，病因，出血大小和其他结果的其他潜在预测指标。假设：1）在患有较大出血的儿童中，结局会更糟，在脑室内出血的患者中，2）神经系统效果较差的患者的出血位置将与患有良好神经学结果的出血位置不同，3）出血大小和位置将是结果的独立预测因子。因此，两者的分数对于创建预测结果的公式很重要。目标2是确定颅内压（ICP）和脑自动调节的测量是否也可以预测儿童时期后的结果。将评估脑氧合指数（COX）的新型大脑自动调节指标。 COX通过近红外光谱（NIR）和动脉血压进行非侵入性测量。假设：1）在ICH后的前24小时内表现出脑自动调节衰竭的儿童在3和12个月后的ICH后会较差。 COX可以提供可用于患者管理的脑自动调节的非侵入性测量。公共卫生相关性：这项研究将更好地理解预测儿童童年后神经系统结果的因素，这是儿童死亡率和终身残疾的重要原因，并将为包括治疗试验在内的患者护理中的未来进步奠定基础。