Related Experiment Video
Updated: Dec 25, 2025
Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
Published on: February 22, 2020
Predicting Recovery and Outcome after Pediatric Stroke: Results from the International Pediatric Stroke Study
Ryan J Felling1, Mubeen F Rafay2, Timothy J Bernard3
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Pediatric arterial ischemic stroke outcomes are often favorable, but neurological impairment is common. Children aged 28 days to 1 year face a vulnerable period, highlighting the need for targeted therapies.
Area of Science:
- Neurology
- Pediatric Medicine
- Stroke Research
Background:
- Pediatric arterial ischemic stroke (AIS) affects children, with varying recovery patterns.
- Understanding predictors of recovery and long-term outcomes is crucial for effective management.
Purpose of the Study:
- To identify factors predicting recovery and outcomes in pediatric AIS.
- To investigate the influence of age on stroke recovery in children.
Main Methods:
- Analysis of 587 children from the International Pediatric Stroke Study (2003-2014) with 2-year follow-up.
- Outcomes assessed at discharge and 2 years using clinician grading and the Pediatric Stroke Outcome Measure.
- Demographic, clinical, and radiologic data were examined for outcome predictors.
Main Results:
- Moderate to severe neurological impairment was observed in 48.8% of children at discharge, improving to 24.7% at 2 years.
- Key predictors of poor outcome included age between 28 days and 1 year (OR=3.58), chronic disorders (OR=2.23), and involvement of multiple vascular territories (OR=2.84).
- Emerging deficits were more common in children under 1 year.
Conclusions:
- Pediatric stroke outcomes are generally favorable but significant neurological impairments persist.
- The period between 28 days and 1 year represents a particularly vulnerable stage for pediatric stroke recovery.
- Identifying recovery predictors and timing is essential for family counseling and targeted therapeutic interventions.
Objective:
To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke.
Methods:
We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with 2-year follow-up after arterial ischemic stroke. Outcomes were defined at discharge by clinician grading and at 2 years by the Pediatric Stroke Outcome Measure. Demographic, clinical, and radiologic outcome predictors were examined. We defined changes in outcome from discharge to 2 years as recovery (improved outcome), emerging deficit (worse outcome), or no change.
Results:
Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients. Moderate to severe neurological impairment was present in 9.4% of neonates versus 48.8% of children at discharge compared to 8.0% versus 24.7% after 2 years. Predictors of poor outcome included age between 28 days and 1 year (compared to neonates, odds ratio [OR] = 3.58, p < 0.05), underlying chronic disorder (OR = 2.23, p < 0.05), and involvement of both small and large vascular territories (OR = 2.84, p < 0.05). Recovery patterns differed, with emerging deficits more common in children <1 year of age (p < 0.05).
Interpretation:
Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common. Age between 28 days and 1 year appears to be a particularly vulnerable period. Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke. ANN NEUROL 2020;87:840-852.
