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High critical care usage due to pediatric stroke: results of a population-based study
Christine K Fox1, S Claiborne Johnston, Stephen Sidney
1Department of Neurology, University of California, San Francisco, CA, USA. foxc@neuropeds.ucsf.edu
Insights
Pediatric stroke frequently requires intensive care unit (ICU) admission, intubation, and decompressive neurosurgery, especially for hemorrhagic stroke cases. These interventions appear justified by the high utilization rates and outcomes in children with stroke.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Public Health
Background:
- Childhood stroke is a significant cause of acquired brain injury in children.
- Understanding critical care utilization and outcomes is crucial for optimizing management.
Purpose of the Study:
- To quantify intensive care unit (ICU) admission, intubation, and decompressive craniotomy rates in children with ischemic and hemorrhagic stroke.
- To identify predictors of critical care needs and evaluate discharge outcomes in this population.
Main Methods:
- Retrospective analysis of a large, population-based cohort of children with stroke (1993-2003).
- Inclusion criteria: symptomatic stroke in patients aged >28 days to 19 years.
- Data abstraction from electronic health records and chart review; multivariate logistic regression for analysis.
Main Results:
- 61% of 256 pediatric stroke cases were admitted to the ICU; 32% required intubation; 11% underwent decompressive neurosurgery.
- Hemorrhagic stroke cases showed higher rates: 73% ICU admission, 42% intubation, 19% surgery.
- Altered mental status predicted critical care use; 57% had neurologic deficits at discharge, less common in hemorrhagic stroke.
Conclusions:
- Intensive care unit admission is common in pediatric stroke and supported by high rates of life-saving interventions.
- Hemorrhagic stroke carries a higher burden of critical care interventions compared to ischemic stroke.
- Neurologic deficits at discharge are frequent, highlighting the severity of childhood stroke.
Objectives:
To measure intensive care unit (ICU) admission, intubation, decompressive craniotomy, and outcomes at discharge in a large population-based study of children with ischemic and hemorrhagic stroke.
Methods:
In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993-2003), we identified cases of symptomatic childhood stroke (age >28 days through 19 years) from inpatient and outpatient electronic diagnoses and radiology reports, and confirmed them through chart review. Data regarding stroke evaluation, management, and outcomes at discharge were abstracted. Intensive care unit (ICU) admission, intubation, and decompressive neurosurgery rates were measured, and multivariate logistic regression was used to identify predictors of critical care usage and outcomes at discharge.
Results:
Of 256 cases (132 hemorrhagic and 124 ischemic), 61% were admitted to the ICU, 32% were intubated, and 11% were treated with a decompressive neurosurgery. Rates were particularly high among children with hemorrhagic stroke (73% admitted to the ICU, 42% intubated, and 19% received a decompressive neurosurgery). Altered mental status at presentation was the most robust predictor for all 3 measures of critical care utilization. Neurologic deficits at discharge were documented in 57%, and were less common after hemorrhagic than ischemic stroke: 48% vs 66% (odds ratio 0.5, 95% confidence interval 0.3-0.8). Case fatality was 4% overall, 7% among children admitted to the ICU, and was similar between ischemic and hemorrhagic stroke.
Conclusions:
ICU admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression.
Related Concept Videos
01:17Hemorrhagic Stroke l: Introduction
01:29Hemorrhagic Stroke ll: Pathophysiology
01:15Ischemic Stroke ll: Pathophysiology