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Mortality After Pediatric Arterial Ischemic Stroke
Lauren A Beslow1, Michael M Dowling2, Sahar M A Hassanein3
1Division of Neurology, Children's Hospital of Philadelphia, and Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; beslow@email.chop.edu.
Insights
Pediatric arterial ischemic stroke (AIS) has a 2.6% in-hospital mortality rate, primarily due to stroke complications. Congenital heart disease and extensive stroke are key risk factors for mortality in children with AIS.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Diseases
- Epidemiology
Background:
- Cerebrovascular disease is a leading cause of death in US children.
- Risk factors for mortality in pediatric arterial ischemic stroke (AIS) are not well understood.
Purpose of the Study:
- To identify predictors of in-hospital mortality in pediatric AIS cases.
- To analyze associations between risk factors and mortality in a multinational stroke registry.
Main Methods:
- Retrospective analysis of pediatric AIS cases from a multinational registry (January 2003 - July 2014).
- Logistic regression used to identify risk factors for in-hospital mortality.
- Causes of death ascertained from medical records.
Main Results:
- Overall in-hospital mortality for pediatric AIS was 2.6% (1.5% in neonates, 3.1% in children).
- Stroke-related deaths accounted for 64.6% of reported causes.
- Significant mortality predictors included congenital heart disease and posterior plus anterior circulation stroke for both neonates and children. Neonatal mortality was also linked to stroke presentation without seizures; childhood mortality was associated with Hispanic ethnicity.
Conclusions:
- Congenital heart disease and extensive stroke (posterior plus anterior circulation) are significant risk factors for in-hospital mortality in pediatric AIS.
- Understanding and addressing these risk factors, alongside ethnicity and seizure presentation, can improve survival rates.
- Further research into mortality predictors is crucial for enhancing outcomes in pediatric stroke.
Objectives:
Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS).
Methods:
Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality.
Results:
Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were stroke-related, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children.
Conclusions:
In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.
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