Factors Influencing Long-Term Outcomes in Childhood Arterial Ischemic Stroke

Childhood arterial ischemic stroke (AIS) is associated with substantial long-term morbidity. This study aims to describe factors associated with recurrence, mortality, and neurological disability.

Australian children with radiologically confirmed AIS were enrolled prospectively to the Royal Children's Hospital stroke registry from 2003 to 2017. Data collected included demographics, clinical and radiological variables, Pediatric National Institutes of Health Stroke Scale severity score, and the Childhood AIS Standardized Classification and Diagnostic Evaluation etiology. Neurological outcomes were categorized as good (normal) or poor (mild/moderate/severe) using the Pediatric Stroke Outcome Measure Severity Classification Scheme.

A total of 172 children with AIS were identified; 11% died (2% stroke-related), 15% had recurrent strokes (5% transient ischemic attacks), and 8% developed epilepsy. Pediatric Stroke Outcome Measure follow-up data were available for 131 children at a median 8.9 years of follow-up (interquartile range, 6.0-11.9). Risk factors for recurrence were arteriopathy (hazard ratio [HR], 2.75; confidence interval [CI], 1.47-5.15, P = 0.002) and hemiparesis (HR, 1.34; CI, 1.07-1.69, P = 0.012); 43% of children had poor long-term outcomes, which were associated with altered conscious state (odds ratio [OR], 2.79; CI, 1.25-6.22, P = 0.012) and neurosurgical intervention (OR, 3.20; CI, 1.55-6.59, P = 0.002).

Long-term neurological deficits are common in children with AIS in the prereperfusion therapy era. The use of pediatric-specific stroke assessment measures and etiologic classification systems enables this study to be a comparator for future stroke studies, measuring the impact of reperfusion therapies on outcomes in childhood AIS.