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Published on: November 26, 2013
Thrombolysis for ischemic stroke in children: data from the nationwide inpatient sample
Nazli Janjua1, Abu Nasar, John K Lynch
1Long Island College Hospital, Department of Neurology, Brooklyn, NY 11201, USA. NJanjua@chpnet.org
Insights
Thrombolytic therapy is rarely used in pediatric ischemic stroke patients, with unclear benefits. Further research is needed to assess the safety and effectiveness of thrombolysis in children.
Area of Science:
- Pediatric Neurology
- Cardiovascular Research
- Medical Interventions
Background:
- Thrombolysis is a critical treatment for ischemic stroke in adults.
- Limited data exists on the use and outcomes of thrombolysis in pediatric populations.
- Pediatric stroke represents a significant clinical challenge with potential for long-term disability.
Purpose of the Study:
- To determine the national incidence of thrombolysis administration in pediatric ischemic stroke cases.
- To analyze demographic, clinical, and economic factors associated with thrombolysis in children.
- To evaluate initial outcomes for pediatric patients receiving thrombolytic therapy.
Main Methods:
- Analysis of the Nationwide Inpatient Sample (NIS) database from 2000-2003.
- Inclusion criteria: patients aged 1-17 years with International Classification of Diseases (ICD) codes for ischemic stroke.
- Comparison of characteristics and outcomes between children who received thrombolysis and those who did not.
Main Results:
- An estimated 2904 pediatric ischemic stroke admissions occurred between 2000-2003.
- Only 46 children (1.6%) received thrombolytic therapy.
- Children receiving thrombolysis were older, predominantly male, incurred higher hospital costs, and had worse discharge outcomes (higher mortality/dependency).
Conclusions:
- Thrombolysis is infrequently administered to pediatric ischemic stroke patients.
- The clinical benefit and safety of thrombolysis in children remain uncertain.
- Larger, prospective studies are essential to guide the appropriate use of thrombolysis in pediatric stroke.
Background And Purpose:
Few pediatric reports of thrombolysis exist. We sought to determine national rates of thrombolysis among pediatric ischemic stroke patients using a national database.
Methods:
Patients between the ages of 1 and 17 years, entered in the Nationwide Inpatient Sample between 2000 and 2003, with International Classification of Diseases codes for ischemic stroke were included in the study. Differences in mean age, gender distribution, ethnicity, secondary diagnoses, medical complications, associated procedure rates, modes of discharge, and hospital costs between pediatric stroke patients receiving and not receiving thrombolysis were estimated.
Results:
In the United States, between 2000 and 2003 an estimated 2904 children were admitted with ischemic stroke, of which 46 children (1.6%) received thrombolytic therapy. Children who received thrombolysis were on the average older (11 versus 9 years), more likely to be male (100% versus 53.8%), with significantly higher hospital costs ($81,800 versus $38,700). These children were also less likely to be discharged home with higher rates of death and dependency, although differences in clinical severity between the 2 groups was not known.
Conclusions:
Thrombolysis, though not indicated for patients <18 years of age, is currently being administered to children, with unclear benefit. Larger studies are needed to evaluate the safety and efficacy of this treatment for children.
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