Cerebral Venous Sinus Thrombosis in Pediatric Critical Care.

IMPORTANCE: Pediatric cerebral venous sinus thrombosis (CVST) is being increasingly recognized and can pose substantial risks of morbidity and mortality. Data on the epidemiology, management, and outcomes of CVST in the PICU remain limited.

OBJECTIVES: To describe the clinical characteristics, management, and outcomes of critically ill children with CVST during their admission to the PICU.

DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective observational cohort study in a quaternary PICU in Toronto, Canada, between 2018 and 2023. Patients 18 years old and younger with acute primary CVST (CVST being the primary indication for ICU admission) and secondary CVST (diagnosis during an admission for an alternative diagnosis) were included in this study.

MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. Descriptive statistics were used to describe characteristics and outcomes.

RESULTS: Thirty patients were admitted with a diagnosis of CVST: 19 (63%) primary, 11 (37%) secondary. Fourteen (47%) had an associated cerebral infarct, and nine (30%) had an associated intracranial hemorrhage. The most common condition associated with secondary CVST was a brain disease requiring neurosurgical intervention (5/11). Five (17%) children with CVST died in this study, of which four had a primary CVST. Children residing in neighborhoods with increased marginalization were disproportionally represented in this cohort.

CONCLUSIONS AND RELEVANCE: Primary CVST is more common than secondary and is associated with significant mortality. The disproportionate impact on marginalized children emphasizes the need for heightened awareness and determination of factors associated with this finding.