Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based
Andrew A Mallick1, Vijeya Ganesan2, Fenella J Kirkham3
1Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.
Insights
Childhood arterial ischaemic stroke incidence is 1.60 per 100,000 annually. Asian and black children face a higher risk, with incidence highest in infants under one year.
Area of Science:
- Pediatric Neurology
- Epidemiology
- Public Health
Background:
- Childhood arterial ischaemic stroke is a significant cause of acquired brain injury.
- Prospective, population-based studies on childhood arterial ischaemic stroke are limited.
- This study investigates the epidemiology and clinical features of childhood arterial ischaemic stroke.
Purpose of the Study:
- To determine the incidence and epidemiological characteristics of childhood arterial ischaemic stroke.
- To identify clinical features and risk factors associated with childhood arterial ischaemic stroke.
- To explore variations in risk based on age, sex, and race.
Main Methods:
- A population-based cohort study in southern England over one year (July 2008-June 2009).
- Inclusion criteria: Children aged 29 days to 16 years with radiologically confirmed arterial ischaemic stroke.
- Case ascertainment through multiple sources, confirmed by personal examination; capture-recapture analysis used.
Main Results:
- Identified 96 cases, with a crude incidence of 1.60 per 100,000 child-years.
- Incidence was highest in children under 1 year (4.14 per 100,000).
- Asian and black children had a significantly higher risk compared to white children; no sex difference observed.
Conclusions:
- Age and racial group, not sex, are significant factors influencing childhood arterial ischaemic stroke risk.
- Further investigation into these demographic differences may offer causative insights.
- Focal neurological deficits were common presenting features.
Background:
Arterial ischaemic stroke is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood arterial ischaemic stroke have been undertaken. We aimed to investigate the epidemiology and clinical features of childhood arterial ischaemic stroke in a population-based cohort.
Methods:
Children aged 29 days to less than 16 years with radiologically confirmed arterial ischaemic stroke occurring over a 1-year period (July 1, 2008, to June 30, 2009) residing in southern England (population denominator 5·99 million children) were eligible for inclusion. Cases were identified using several sources (paediatric neurologists and trainees, the British Paediatric Neurology Surveillance Unit, paediatricians, radiologists, physiotherapists, neurosurgeons, parents, and the Paediatric Intensive Care Audit Network). Cases were confirmed by personal examination of cases and case notes. Details of presenting features, risk factors, and investigations for risk factors were recorded by analysis of case notes. Capture-recapture analysis was used to estimate completeness of ascertainment.
Findings:
We identified 96 cases of arterial ischaemic stroke. The crude incidence of childhood arterial ischaemic stroke was 1·60 per 100 000 per year (95% CI 1·30-1·96). Capture-recapture analysis suggested that case ascertainment was 89% (95% CI 77-97) complete. The incidence of arterial ischaemic stroke was highest in children aged under 1 year (4·14 per 100 000 per year, 95% CI 2·36-6·72). There was no difference in the risk of arterial ischaemic stroke between sexes (crude incidence 1·60 per 100 000 per year [95% CI 1·18-2·12] for boys and 1·61 per 100 000 per year [1·18-2·14] for girls). Asian (relative risk 2·14, 95% CI 1·11-3·85; p=0·017) and black (2·28, 1·00-4·60; p=0·034) children were at higher risk of arterial ischaemic stroke than were white children. 82 (85%) children had focal features (most commonly hemiparesis) at presentation. Seizures were more common in younger children (≤1 year) and headache was more common in older children (>5 years; p<0·0001). At least one risk factor for childhood arterial ischaemic stroke was identified in 80 (83%) cases.
Interpretation:
Age and racial group, but not sex, affected the risk of arterial ischaemic stroke in children. Investigation of such differences might provide causative insights.
Funding:
The Stroke Association, UK.
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