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Characteristics and Outcomes of Children with Cerebral Sinus Venous Thrombosis
Juan Sebastian Proaño1, Paul A Martinez2,3, Prithvi Sendi2,3
1Marshall University Joan C Edwards School of Medicine, 1600 Medical Center Drive, Huntington, WV, 25705, USA. proanocoello@marshall.edu.
Insights
Cerebral sinus venous thrombosis (CSVT) is rare in children, affecting 26.3 per 100,000. Stroke complications in pediatric CSVT increase mortality and need for mechanical ventilation.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Epidemiology
Background:
- Cerebral sinus venous thrombosis (CSVT) is an uncommon yet serious condition in children.
- Limited large-scale epidemiological data exists for pediatric CSVT.
Purpose of the Study:
- To evaluate the epidemiology of hospitalized children with CSVT in the United States.
- To assess in-hospital outcomes for pediatric patients diagnosed with CSVT.
Main Methods:
- Retrospective cross-sectional analysis using the 2016 and 2019 Kids' Inpatient Database.
- Utilized specific diagnostic codes for CSVT and associated conditions.
- Employed sample weighting for national prevalence and outcome estimations.
Main Results:
- CSVT occurred in 26.3 per 100,000 pediatric discharges, with a U-shaped age distribution.
- 19.3% of children experienced stroke (hemorrhagic or ischemic), associated with higher mortality (OR 2.3) and ventilation needs (OR 2.7).
- Overall mortality was 4.1%; 25.2% required mechanical ventilation, particularly neonates and young children, with significantly increased mortality (OR 16.6).
Conclusions:
- CSVT is uncommon in children and presents a U-shaped age distribution.
- Stroke is a frequent complication of pediatric CSVT, significantly increasing mortality risk and the need for mechanical ventilation.
- Mechanical ventilation is more common in infants with CSVT and is strongly associated with increased mortality across all pediatric age groups.
Background:
Cerebral sinus venous thrombosis (CSVT) is an uncommon condition in children with potentially serious outcomes. Large epidemiological studies in children with CSVT are few. The objective of this study is to evaluate the epidemiology and in-hospital outcomes of hospitalized children with CSVT in the United States.
Methods:
We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database for the combined years 2016 and 2019. The database was queried using the diagnoses for intracranial and intraspinal phlebitis and thrombophlebitis, nonpyogenic thrombosis of the intracranial venous system, and cerebral infarction due to cerebral venous thrombosis. Sample weighting was employed to produce national estimates.
Results:
Of 12,165,621 discharges, 3202 had CSVT (in-hospital prevalence 26.3 per 100,000 discharges). Male patients accounted for 57% of CSVT discharges. The median age was 8 years (interquartile range 1-16), with a U-shaped distribution with peaks in patients younger than 4 years and patients aged between 18 and 20 years. A total of 19.3% of children with CSVT had either hemorrhagic or ischemic stroke. Patients with stroke were more likely to require mechanical ventilation (odds ratio [OR] 2.7; 95% confidence interval [CI] 2.1-3.3; p < 0.001) and have higher mortality (OR 2.3; 95% CI 1.6-3.4; p < 0.001). Mechanical ventilation was necessary for 25.2% of patients with CSVT, of whom the majority were neonates and young children. The need for mechanical ventilation was associated with increased mortality (OR 16.6; 95% CI 9.9-27.9; p < 0.001). The overall mortality rate for CSVT was 4.1%, and 16.5% of patients with CSVT were discharged with home health care or to a skilled nursing facility.
Conclusions:
CSVT, which has a U-shaped age distribution, is an uncommon condition in children. Stroke is common in children with CSVT, and it is associated with an increased need for mechanical ventilation and increased mortality. The need for mechanical ventilation is more common in infants, and it is associated with increased mortality across all age groups.
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