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Long-term outcome after arterial ischemic stroke in children and young adults
Barbara Goeggel Simonetti1, Ariane Cavelti1, Marcel Arnold1
1From the Division of Pediatric Neurology (B.G.S., S.B., M.R., M.S.), University Children's Hospital, Inselspital, and University of Bern; Departments of Neurology (B.G.S., A.C., M.A., H.P.M., U.F.) and Diagnostic and Interventional Neuroradiology (J.G.), Inselspital, University Hospital Bern, and University of Bern; Division of Pediatric Neurology (J.F.), University Hospital Geneva; Division of Pediatric Neurology (P.W.), University Children's Hospital Basel; and Division of Pediatric Neurology (A.H.), University Children's Hospital Zurich, Switzerland.
Insights
Children and young adults with arterial ischemic stroke (AIS) show similar long-term outcomes regarding mortality, disability, and quality of life. Behavioral issues were more common in children, while adults reported greater life impact from AIS.
Area of Science:
- Neurology
- Pediatrics
- Stroke Medicine
Background:
- Arterial ischemic stroke (AIS) in childhood and young adulthood presents unique challenges.
- Long-term outcomes for pediatric and young adult AIS survivors require comprehensive comparison.
Purpose of the Study:
- To compare the long-term functional and psychosocial outcomes of children and young adults following arterial ischemic stroke (AIS).
Main Methods:
- A prospective cohort study analyzed data from two large registries: the Swiss Neuropediatric Stroke Registry and the Bernese stroke database.
- Patients who experienced AIS between 2000-2008 (childhood: 1 month-16 years; young adulthood: 16.1-45 years) with consented follow-up (≥2 years) were included.
Main Results:
- Long-term functional outcomes (modified Rankin Scale 0-1) were similar, with 56% of children and 55% of young adults achieving a favorable outcome.
- Mortality rates (14% children vs. 7% young adults) and recurrence rates did not significantly differ between groups.
- While overall psychosocial outcomes were comparable, children exhibited more behavioral problems, and young adults reported a greater impact of AIS on daily life.
Conclusions:
- Arterial ischemic stroke (AIS) in children and young adults demonstrates comparable long-term prognoses across mortality, disability, and psychosocial variables.
- The Pediatric NIH Stroke Scale/NIH Stroke Scale score emerged as a key predictor of favorable long-term outcomes.
Objective:
To compare long-term outcome of children and young adults with arterial ischemic stroke (AIS) from 2 large registries.
Methods:
Prospective cohort study comparing functional and psychosocial long-term outcome (≥2 years after AIS) in patients who had AIS during childhood (1 month-16 years) or young adulthood (16.1-45 years) between January 2000 and December 2008, who consented to follow-up. Data of children were collected prospectively in the Swiss Neuropediatric Stroke Registry, young adults in the Bernese stroke database.
Results:
Follow-up information was available in 95/116 children and 154/187 young adults. Median follow-up of survivors was 6.9 years (interquartile range 4.7-9.4) and did not differ between the groups (p = 0.122). Long-term functional outcome was similar (p = 0.896): 53 (56%) children and 84 (55%) young adults had a favorable outcome (modified Rankin Scale 0-1). Mortality in children was 14% (13/95) and in young adults 7% (11/154) (p = 0.121) and recurrence rate did not differ (p = 0.759). Overall psychosocial impairment and quality of life did not differ, except for more behavioral problems among children (13% vs 5%, p = 0.040) and more frequent reports of an impact of AIS on everyday life among adults (27% vs 64%, p < 0.001). In a multivariate regression analysis, low Pediatric NIH Stroke Scale/NIH Stroke Scale score was the most important predictor of favorable outcome (p < 0.001).
Conclusion:
There were no major differences in long-term outcome after AIS in children and young adults for mortality, disability, quality of life, psychological, or social variables.
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