(902) Pediatric Brain Arteriovenous Malformations in Pre- and Post-COVID Eras: A Single-Center Experience

Introduction: Brain arteriovenous malformations (bAVM) are rare vascular lesions that form from an abnormal connection between an artery and a vein without an intermediate capillary network. The pathogenesis of bAVM is not well understood, and little is known of its risk factors. In this single-center study, we explored the incidence, patient characteristics, and outcomes of children with bAVM in the pre- and post-COVID-19 eras. We hypothesized there would be an increase in incidence of bAVM during COVID-19 pandemic.

Methods: We identified all patients from 0 to 18 years who were admitted with a diagnosis of bAVM between 2006-2021 to the Children’s Hospital of Michigan. The year of bAVM diagnosis, as well as the patient and bAVM characteristics, were obtained. Outcomes included PICU and hospital length of stay, discharge location, neurologic outcomes at hospital discharge, and mortality. Analysis was done using Fisher exact test for categorical data or Mann-Whitney U test for continuous data. Significance was set as P < .05.

Results: 48 patients were newly diagnosed with bAVM, with incidence of bAVM increased overtime. The median age at diagnosis was 11.0 years [7.8, 15.0]. Most patients were male (68.8%), were of White racial background (53.5%), were born premature (59.5%), and had no family history of AVMs (95.8%). 3 patients (6.3%) were diagnosed with Wyburn Mason’s syndrome. Most patients (85.4%, 41) underwent at least 1 surgical intervention. Median number of surgeries was 2 [1, 3]. Median PICU and hospital LOS was 7.0 days [3.0, 17.5] and 15.0 days [7.0, 30.3], respectively. Most patients (56.3%) were discharged home, the in-hospital mortality was 8.3%. Overall mortality was 10.4% (5). The modified Rankin score at hospital discharge was 0-1 for 35.4% (22) patients, 2-3 for 20.8% (10), and 4-5 for 22.9% (11). The incidence of pediatric bAVM was 0.23 cases per month preCOVID, while the incidence during the COVID-19 pandemic was 0.25 cases per month. No differences noted in patient characteristics or outcomes among the cohort in the pre- and post-COVID eras.

Conclusions: While there has been an increase in the incidence of AVMs, there was no statistically significant difference in the incidence of bAVM in the pre- and post-COVID-19 eras. A larger study sample is needed to confirm our findings.