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Updated: Jun 25, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Risk factors for pediatric ischemic stroke and intracranial hemorrhage: A national electronic health record based
Stuart Fraser1,2, Samantha M Levy3, Amee Moreno2
1Division of Child and Adolescent Neurology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Insights
Pediatric stroke risk factors like hypertension and tobacco exposure were identified in a large US study. This research highlights potential links between common conditions and childhood stroke, warranting further investigation.
Area of Science:
- Pediatric Neurology
- Epidemiology
- Public Health
Background:
- Pediatric stroke is a significant cause of childhood morbidity.
- Understanding its epidemiology and risk factors requires large-scale studies.
- Administrative datasets offer a cost-effective method for identifying stroke risk factors.
Purpose of the Study:
- To utilize a large administrative dataset to assess the prevalence and odds ratios of rare exposures linked to pediatric stroke.
- To generate hypotheses regarding risk factors for childhood stroke.
Main Methods:
- Extracted data for 10,688 patients aged 0-18 with stroke diagnoses (ischemic or hemorrhagic) from the Cerner Health Facts EMR Database (2000-2018).
- Assessed prevalence of potential risk factors using ICD 9 and 10 codes.
- Calculated odds ratios by comparing stroke patients to a control group without stroke.
Main Results:
- Identified 10,688 pediatric stroke cases: 59% ischemic, 41% hemorrhagic.
- Common risk factors for ischemic stroke included hypertension, trauma, and malignancy.
- Common risk factors for hemorrhagic stroke included trauma, malignancy, and arrhythmia.
- High odds ratios were observed for dyslipidemia, hypertension, and tobacco exposure in the ischemic stroke cohort.
Conclusions:
- This large retrospective study provides insights into pediatric stroke risk factors.
- High odds ratios for conditions like hypertension, hyperlipidemia, diabetes, and tobacco exposure suggest a relationship with pediatric stroke.
- Ascertainment bias is a limitation; further focused research is needed to elucidate the role of these exposures in pediatric stroke pathogenesis.
Background:
Stroke is an important cause of morbidity in pediatrics. Large studies are needed to better understand the epidemiology, pathogenesis and risk factors associated with pediatric stroke. Large administrative datasets can provide information on risk factors in perinatal and childhood stroke at low cost. The aim of this hypothesis-generating study was to use a large administrative dataset to assess for prevalence and odds-ratios of rare exposures associated with pediatric stroke.
Methods:
The data for patients aged 0-18 with a diagnosis of either ischemic stroke or intracranial hemorrhage were extracted from the Cerner Health Facts EMR Database from 2000 to 2018. Prevalence of various possible risk factors for pediatric and adult stroke was assessed using ICD 9 and 10 codes. Odds ratios were calculated using a control group of patients without stroke.
Results:
10,688 children were identified with stroke. 6339 (59 %) were ischemic and 4349 (41 %) were hemorrhagic. The most frequently identified risk factors for ischemic stroke across age groups were hypertension (29-44 %), trauma (19-33 %), and malignancy (11-24 %). The most common risk factors seen with hemorrhagic stroke were trauma (32-64 %), malignancy (5-19 %) and arrhythmia (9-12 %). Odds ratios across all age groups for dyslipidemia (17-64), hypertension (20-63), and tobacco exposure (3-59) were high in the ischemic stroke cohort.
Conclusion:
This is the largest retrospective study of pediatric stroke of its kind from hospitals across the US in both academic and non-academic clinical settings. Much of our data was consistent with prior studies. ICD codes for tobacco exposure, hyperlipidemia, diabetes, and hypertension all had high odds ratios for stroke in children, which suggest a relationship between these conditions and pediatric stroke. However, ascertainment bias is a major concern with electronic health record-based studies. More focused study is needed into the role of these exposures into the pathogenesis of pediatric stroke.
