Association of Physiologic Parameters with Neurologic Outcome After Arteriovenous Malformation Rupture in Children

Evidence to guide the critical care management of children with ruptured brain arteriovenous malformations is lacking. We aimed to determine whether there are associations between physiologic parameters and outcome in children with ruptured brain arteriovenous malformations. We performed a single-center retrospective review of patients ≤18 years of age with a ruptured brain arteriovenous malformation from 2011 to 2023. Categorization of outcome was based on the Pediatric Stroke Outcome Measure. Descriptive statistics were used. Most patients with an arteriovenous malformation rupture had a poor outcome at discharge (31/49, 63%) and in follow-up at 3-12 months (21/37, 57%). Patients who were normothermic and normoglycemic for the first 7 days after arteriovenous malformation rupture were less likely to have a poor outcome at discharge than those who had a temperature ≥38 °C (odds ratio [OR] 0.14, 95% confidence interval [CI] 0.04-0.52; <i>P</i> = .01) or a blood glucose ≥200 mg/dL (OR 0.11, 95% CI 0.01-0.92; <i>P</i> = .04). A lower minimum hemoglobin concentration (10.00 g/dL [standard deviation (SD) 1.67] vs 12.46 g/dL [SD 6.29], <i>t</i>(47) 2.07, <i>P</i> = .04) and a higher average partial pressure of carbon dioxide (Paco₂) (40.98 mm Hg [SD 4.30] vs 35.58 mm Hg [SD 7.72], <i>t</i>(47) -2.09, <i>P</i> = .046) were also associated with a poor discharge outcome. A higher average maximum temperature was associated with a poor outcome in follow-up (37.46° C [SD 0.49] vs 37.09 °C [SD 0.59], <i>t</i>(47) -2.09; <i>P</i> = .04). Temperature, blood glucose, hemoglobin concentration, and Paco₂ are potentially modifiable parameters that could be targeted by quality improvement interventions to improve outcomes in this population.