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Background and Purpose -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 c laim is limited. Methods -To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of Californi a, San Francisco (January 2000 to December 2004; n=400) and Kaiser Permanente No rthern California (January 1993 to December 2004; n=819). In Kaplan-Meier survi val anal yses, the index date was the date of initial BAVM detection; cases were censor ed at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment, or loss to follow-up. Cox proportional haz ards models included childhood presentation ( < 20 years old), hemorrhagic prese ntation, and other potential confounders. Results -Our study included 996 perso n-years of follow-up in the childhood presentation group and 3260 in the adult presentation group. In the unadjusted survival analysis, the subsequent ICH rat es 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). Conclusions -Children with BAVMs do not a ppear 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 adul ts.
Background and Purpose -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 c laim is limited. Methods -To compare the risk of ICH in children versus adults with BAVM, we studied all cases of BAVM evaluated at the University of Californi a, San Francisco (January 2000 to December 2004; n = 400) and Kaiser Permanente Northern California (January 1993 to December 2004; n = 819). In Kaplan-Meier survivin analgesies, the index date was the date of initial bAVM detection; cases were censor ed at time of subsequent ICH (the primary outcome, defined as ICH after initial presentation), first BAVM treatment , or loss to follow-up. Cox proportional haz ards models included childhood presentation (<20 years old), hemorrhagic prese ntation, and other potential confounders. Results -Our study included 996 perso n-years of follow-up in the chil dhood presentation group and 3260 in the adult presentation group. In the unadjusted survival analysis, the subsequent ICH patients were similar for the 2 age groups (average annual rate 2.0% for children; 2.2% for adults; P = 0.82 by log-rank 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). Conclusions -Children with BAVM do not a ppear 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 adul ts.