Background Pediatric brain arteriovenous malformations (AVMs) such as Vein of Galen Malformations can present acutely in the neonatal population with high-output heart failure, hydrocephalus, severe neurologic impairment, and death. Infants can present with hydrocephalus and delayed developmental milestones. Strategies for diagnosis, acute, and non-acute management have rapidly evolved over the last two decades. We sought to characterize how outcomes have changed over time for patients with pediatric AVMs.
Methods A query of the 2005-2019 National Inpatient Sample was performed for patients admitted with an AVM (ICD-9 747.81, ICD-10 Q28.2) under one year of age. Patients were stratified depending on the presence or absence of heart failure. Demographics, comorbidities, and outcomes were identified. Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated using variables with standardized mean differences >0.1. Significance set at an alpha level of <0.01. Incidence and mortality were plotted against time. All analysis performed in R version 4.1.3.
Results Of 1,332 patients with AVMs under the age of 1 year old, 663 (49.77%) presented with heart failure. These patients had higher Elixhauser Comorbidity Scores (12.25 ± 5.41 vs. 6.55 ± 6.46; p<0.001). On univariate analysis, patients with pediatric AVMs presenting with heart failure were more likely to be younger, use ventilators, experience fluid or electrolyte disorders, and receive early angiograms and embolizations (all p<0.001). After propensity matching, Elixhauser Comorbidity Score, ventilator usage, and endovascular embolization remained significant. Patients with heart failure were more likely to be admitted to an urban teaching hospital (p=0.008), experienced significantly greater in-hospital mortality (25.8% vs. 6.5%; p<0.001), and were less likely to be discharged home (64.7% vs. 85.4%; p<0.001. When plotted against time, mortality and percent mortality have improved over the last 15 years.
Conclusions In this 15-year nationally representative propensity matched analysis of pediatric patients with AVMs, patients in heart failure were likely to present younger and experience greater in-hospital morbidity and mortality. However, over the last 15 years mortality has decreased in this population. This suggests that advances in treatment strategy are contributing to improved patient outcomes.
Disclosures A. Devarajan: None. T. Hardigan: None. J. Bonet: None. M. Sorscher: None. S. Majidi: None. T. Shigematsu: None. A. Berenstein: None. J. Fifi: None.
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