Abstract
Pediatric intracerebral hemorrhage (pICH) is a rare but serious neurologic emergency associated with significant morbidity. Although pICH accounts for nearly half of all pediatric strokes, it remains understudied, and dedicated evidence-based management guidelines are lacking. To address this gap, the International Pediatric Stroke Organization convened a multidisciplinary international working group in 2020 to develop a comprehensive, consensus-based framework for the acute evaluation and management of pICH in children aged 28 days to 18 years. The working group included child neurologists, neurointensivists, neurosurgeons, neuroradiologists, and neurointerventionalists. Subgroups conducted systematic literature reviews and formulated key clinical questions. A modified Delphi process was used to derive consensus statements across 6 domains: prehospital and emergency care, diagnostic imaging and workup, neurocritical care and medical management, neurosurgical and neurointerventional approaches, and identification of knowledge gaps. Through rounds of structured review and voting, 21 consensus statements were developed and approved. The process was endorsed by multiple professional societies. This represents the first international, multidisciplinary, multisociety consensus statement focused on the acute management of pICH in children. It provides structured, expert-driven guidance to inform clinical decision-making, reduce practice variability, and highlight areas for future research. These consensus statements aim to support clinicians worldwide in improving outcomes for children with pICH.