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Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations
Children with brain arteriovenous malformations (BAVMs) are said to be at higher risk for intracranial hemorrhage (ICH) than adults. Although this notion affects treatment decisions, the evidence to support this claim is limited. To compare the risk of ICH in children versus adults with BAVM, we stu...
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| Published in: | Stroke (1970) 2005-10, Vol.36 (10), p.2099-2104 |
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| container_end_page | 2104 |
| container_issue | 10 |
| container_start_page | 2099 |
| container_title | Stroke (1970) |
| container_volume | 36 |
| creator | FULLERTON, Heather J ACHROL, Achal S JOHNSTON, S. Claiborne MCCULLOCH, Charles E HIGASHIDA, Randall T LAWTON, Michael T SIDNEY, Stephen YOUNG, William L |
| description | Children with brain arteriovenous malformations (BAVMs) are said to be at higher risk for intracranial hemorrhage (ICH) than adults. Although this notion affects treatment decisions, the evidence to support this claim is limited.
To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of California, San Francisco (January 2000 to December 2004; n=400) and Kaiser Permanente Northern California (January 1993 to December 2004; n=819). In Kaplan-Meier survival analyses, the index date was the date of initial BAVM detection; cases were censored at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment, or loss to follow-up. Cox proportional hazards models included childhood presentation ( |
| doi_str_mv | 10.1161/01.STR.0000181746.77149.2b |
| format | article |
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To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of California, San Francisco (January 2000 to December 2004; n=400) and Kaiser Permanente Northern California (January 1993 to December 2004; n=819). In Kaplan-Meier survival analyses, the index date was the date of initial BAVM detection; cases were censored at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment, or loss to follow-up. Cox proportional hazards models included childhood presentation (<20 years old), hemorrhagic presentation, and other potential confounders.
Our study included 996 person-years of follow-up in the childhood presentation group and 3260 in the adult presentation group. In the unadjusted survival analysis, the subsequent ICH rates were similar for the 2 age groups (average annual rate 2.0% for children; 2.2% for adults; P=0.82 by log-rank test). BAVMs in childhood were more likely to present initially with ICH (P<0.001). After adjustment for presentation in the multivariate model, subsequent ICH rates were lower in children (hazard ratio, 0.10; 95% CI, 0.01 to 0.86; P=0.036).
Children with BAVMs do not appear to be at increased risk for a subsequent ICH compared with adults, and may even be relatively protected. Confounding by hemorrhagic presentation should be considered in any study comparing BAVM hemorrhage rates in children versus adults.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/01.STR.0000181746.77149.2b</identifier><identifier>PMID: 16141419</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Age Factors ; Aged ; Biological and medical sciences ; Cerebral Hemorrhage - diagnosis ; Cerebral Hemorrhage - epidemiology ; Cerebral Hemorrhage - etiology ; Child ; Child, Preschool ; Cohort Studies ; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology ; Female ; Follow-Up Studies ; Humans ; Intracranial Arteriovenous Malformations - complications ; Intracranial Arteriovenous Malformations - diagnosis ; Intracranial Arteriovenous Malformations - epidemiology ; Intracranial Arteriovenous Malformations - pathology ; Male ; Medical sciences ; Middle Aged ; Neurology ; Neuropharmacology ; Neurotransmitters. Neurotransmission. Receptors ; Non tumoral diseases ; Odds Ratio ; Otorhinolaryngology. Stomatology ; Pharmacology. Drug treatments ; Proportional Hazards Models ; Risk ; Sensitivity and Specificity ; Serotoninergic system ; Survivors ; Time Factors ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2005-10, Vol.36 (10), p.2099-2104</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-580bdf5f16d858d4393f61e4aed2157e61328ced1b85b24ca0dfa17c332153f03</citedby><cites>FETCH-LOGICAL-c436t-580bdf5f16d858d4393f61e4aed2157e61328ced1b85b24ca0dfa17c332153f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17204099$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16141419$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FULLERTON, Heather J</creatorcontrib><creatorcontrib>ACHROL, Achal S</creatorcontrib><creatorcontrib>JOHNSTON, S. Claiborne</creatorcontrib><creatorcontrib>MCCULLOCH, Charles E</creatorcontrib><creatorcontrib>HIGASHIDA, Randall T</creatorcontrib><creatorcontrib>LAWTON, Michael T</creatorcontrib><creatorcontrib>SIDNEY, Stephen</creatorcontrib><creatorcontrib>YOUNG, William L</creatorcontrib><creatorcontrib>UCSF BAVM Study Project</creatorcontrib><title>Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Children with brain arteriovenous malformations (BAVMs) are said to be at higher risk for intracranial hemorrhage (ICH) than adults. Although this notion affects treatment decisions, the evidence to support this claim is limited.
To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of California, San Francisco (January 2000 to December 2004; n=400) and Kaiser Permanente Northern California (January 1993 to December 2004; n=819). In Kaplan-Meier survival analyses, the index date was the date of initial BAVM detection; cases were censored at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment, or loss to follow-up. Cox proportional hazards models included childhood presentation (<20 years old), hemorrhagic presentation, and other potential confounders.
Our study included 996 person-years of follow-up in the childhood presentation group and 3260 in the adult presentation group. In the unadjusted survival analysis, the subsequent ICH rates were similar for the 2 age groups (average annual rate 2.0% for children; 2.2% for adults; P=0.82 by log-rank test). BAVMs in childhood were more likely to present initially with ICH (P<0.001). After adjustment for presentation in the multivariate model, subsequent ICH rates were lower in children (hazard ratio, 0.10; 95% CI, 0.01 to 0.86; P=0.036).
Children with BAVMs do not appear to be at increased risk for a subsequent ICH compared with adults, and may even be relatively protected. Confounding by hemorrhagic presentation should be considered in any study comparing BAVM hemorrhage rates in children versus adults.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cerebral Hemorrhage - diagnosis</subject><subject>Cerebral Hemorrhage - epidemiology</subject><subject>Cerebral Hemorrhage - etiology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intracranial Arteriovenous Malformations - complications</subject><subject>Intracranial Arteriovenous Malformations - diagnosis</subject><subject>Intracranial Arteriovenous Malformations - epidemiology</subject><subject>Intracranial Arteriovenous Malformations - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Neuropharmacology</subject><subject>Neurotransmitters. Neurotransmission. Receptors</subject><subject>Non tumoral diseases</subject><subject>Odds Ratio</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Pharmacology. Drug treatments</subject><subject>Proportional Hazards Models</subject><subject>Risk</subject><subject>Sensitivity and Specificity</subject><subject>Serotoninergic system</subject><subject>Survivors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><recordid>eNpFkMtKAzEUhoMoWquvIIOguxlzcpuMOyneoCB42bgJmSTTRueiybTi2xu10JxFFuf7T3I-hE4BFwACLjAUT8-PBU4HJJRMFGUJrCpIvYMmwAnLmSByF00wplVOWFUdoMMY3xJPqOT76CBNYamqCXqdD_0iH13osqXrhhCWeuGy4ON75vvMLH1rg-uztQtxFTNtV-0Ysy8_LrM66ETokLJ-WLt-SP1Ot80QOj36oY9HaK_RbXTHm3uKXm6un2d3-fzh9n52Nc8No2LMucS1bXgDwkouLaMVbQQ4pp0lwEsngBJpnIVa8powo7FtNJSG0tSmDaZTdP4_9yMMnysXR9X5aFzb6t6lTykhBeU8rT5Fl_-gCUOMwTXqI_hOh28FWP2aVRhUMqu2ZtWfWUXqFD7ZvLKqO2e30Y3KBJxtAB1N8hB0b3zcciXBDFcV_QGS9YOo</recordid><startdate>20051001</startdate><enddate>20051001</enddate><creator>FULLERTON, Heather J</creator><creator>ACHROL, Achal S</creator><creator>JOHNSTON, S. Claiborne</creator><creator>MCCULLOCH, Charles E</creator><creator>HIGASHIDA, Randall T</creator><creator>LAWTON, Michael T</creator><creator>SIDNEY, Stephen</creator><creator>YOUNG, William L</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20051001</creationdate><title>Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations</title><author>FULLERTON, Heather J ; ACHROL, Achal S ; JOHNSTON, S. Claiborne ; MCCULLOCH, Charles E ; HIGASHIDA, Randall T ; LAWTON, Michael T ; SIDNEY, Stephen ; YOUNG, William L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-580bdf5f16d858d4393f61e4aed2157e61328ced1b85b24ca0dfa17c332153f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cerebral Hemorrhage - diagnosis</topic><topic>Cerebral Hemorrhage - epidemiology</topic><topic>Cerebral Hemorrhage - etiology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intracranial Arteriovenous Malformations - complications</topic><topic>Intracranial Arteriovenous Malformations - diagnosis</topic><topic>Intracranial Arteriovenous Malformations - epidemiology</topic><topic>Intracranial Arteriovenous Malformations - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Neuropharmacology</topic><topic>Neurotransmitters. Neurotransmission. Receptors</topic><topic>Non tumoral diseases</topic><topic>Odds Ratio</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Pharmacology. Drug treatments</topic><topic>Proportional Hazards Models</topic><topic>Risk</topic><topic>Sensitivity and Specificity</topic><topic>Serotoninergic system</topic><topic>Survivors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FULLERTON, Heather J</creatorcontrib><creatorcontrib>ACHROL, Achal S</creatorcontrib><creatorcontrib>JOHNSTON, S. Claiborne</creatorcontrib><creatorcontrib>MCCULLOCH, Charles E</creatorcontrib><creatorcontrib>HIGASHIDA, Randall T</creatorcontrib><creatorcontrib>LAWTON, Michael T</creatorcontrib><creatorcontrib>SIDNEY, Stephen</creatorcontrib><creatorcontrib>YOUNG, William L</creatorcontrib><creatorcontrib>UCSF BAVM Study Project</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FULLERTON, Heather J</au><au>ACHROL, Achal S</au><au>JOHNSTON, S. Claiborne</au><au>MCCULLOCH, Charles E</au><au>HIGASHIDA, Randall T</au><au>LAWTON, Michael T</au><au>SIDNEY, Stephen</au><au>YOUNG, William L</au><aucorp>UCSF BAVM Study Project</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2005-10-01</date><risdate>2005</risdate><volume>36</volume><issue>10</issue><spage>2099</spage><epage>2104</epage><pages>2099-2104</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Children with brain arteriovenous malformations (BAVMs) are said to be at higher risk for intracranial hemorrhage (ICH) than adults. Although this notion affects treatment decisions, the evidence to support this claim is limited.
To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of California, San Francisco (January 2000 to December 2004; n=400) and Kaiser Permanente Northern California (January 1993 to December 2004; n=819). In Kaplan-Meier survival analyses, the index date was the date of initial BAVM detection; cases were censored at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment, or loss to follow-up. Cox proportional hazards models included childhood presentation (<20 years old), hemorrhagic presentation, and other potential confounders.
Our study included 996 person-years of follow-up in the childhood presentation group and 3260 in the adult presentation group. In the unadjusted survival analysis, the subsequent ICH rates were similar for the 2 age groups (average annual rate 2.0% for children; 2.2% for adults; P=0.82 by log-rank test). BAVMs in childhood were more likely to present initially with ICH (P<0.001). After adjustment for presentation in the multivariate model, subsequent ICH rates were lower in children (hazard ratio, 0.10; 95% CI, 0.01 to 0.86; P=0.036).
Children with BAVMs do not appear to be at increased risk for a subsequent ICH compared with adults, and may even be relatively protected. Confounding by hemorrhagic presentation should be considered in any study comparing BAVM hemorrhage rates in children versus adults.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16141419</pmid><doi>10.1161/01.STR.0000181746.77149.2b</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Age Factors Aged Biological and medical sciences Cerebral Hemorrhage - diagnosis Cerebral Hemorrhage - epidemiology Cerebral Hemorrhage - etiology Child Child, Preschool Cohort Studies Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology Female Follow-Up Studies Humans Intracranial Arteriovenous Malformations - complications Intracranial Arteriovenous Malformations - diagnosis Intracranial Arteriovenous Malformations - epidemiology Intracranial Arteriovenous Malformations - pathology Male Medical sciences Middle Aged Neurology Neuropharmacology Neurotransmitters. Neurotransmission. Receptors Non tumoral diseases Odds Ratio Otorhinolaryngology. Stomatology Pharmacology. Drug treatments Proportional Hazards Models Risk Sensitivity and Specificity Serotoninergic system Survivors Time Factors Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | Long-term hemorrhage risk in children versus adults with brain arteriovenous malformations |
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