ORIGINAL RESEARCH article
Front. Neurol.
Sec. Pediatric Neurology
Etiology and early clinical predictors of neurological outcomes in pediatric spontaneous intracranial hemorrhage: A retrospective exploratory study
Provisionally accepted
- Hebei Children’s Hospital, Shijiazhuang, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: 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. Methods: 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. Results: 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). Conclusion: 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.
Keywords: etiology, Glasgow Coma Scale, Modified Rankin scale, pediatric spontaneous intracranial hemorrhage, prognostic factors, seizure
Received: 20 Nov 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Hou, Wang and Fang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiangshun Fang
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.