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Published on: April 21, 2017
Incidence and Prognosis of Pediatric Stroke in Denmark: A Nationwide Population-Based Study
Julie Brix Bindslev1,2, Jan Brink Valentin3, Søren P Johnsen3
1Department of Neurology, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Insights
Pediatric stroke incidence rose in boys but not girls between 2013-2020. This study highlights substantial morbidity and mortality, emphasizing the need for improved pediatric stroke care.
Area of Science:
- Neurology
- Pediatrics
- Epidemiology
Background:
- Pediatric stroke is a significant health concern.
- Understanding incidence trends and prognosis is crucial for public health initiatives.
Purpose of the Study:
- To estimate incidence rates and changes in pediatric stroke from 2013-2020 in Denmark.
- To assess the prognosis, including mortality and morbidity, of pediatric stroke.
Main Methods:
- Nationwide Danish registry data for children aged 29 days to 17 years with first-ever stroke (2013-2020).
- Medical record review for validation.
- Poisson regression for incidence rates; Kaplan-Meier for mortality risks.
Main Results:
- Age-adjusted stroke incidence increased in males (driven by arterial ischemic stroke) but remained stable in females.
- 30-day, 1-year, and 5-year cumulative mortality risks were 7.7%, 10.0%, and 11.0%, respectively.
- Mortality risk was stable over time; significant neurologic impairment was observed in survivors.
Conclusions:
- Pediatric stroke incidence rose in males, necessitating targeted prevention and management strategies.
- Substantial morbidity and mortality underscore the need for enhanced pediatric stroke care protocols.
Background And Objectives:
The aim of this study was to estimate incidence rates, changes in incidence rates, and prognosis of pediatric stroke in Denmark from 2013 to 2020.
Methods:
Through a nationwide register, we identified all children (age 29 days-17 years) registered with a first-ever stroke or stroke-related diagnosis between 2013 and 2020. Possible stroke events were validated by medical record review. Age-adjusted incidence rates and absolute changes in incidence rates were estimated by Poisson regression analysis. Kaplan-Meier analysis was used to estimate 30-day, 1-year, and 5-year cumulative mortality risks.
Results:
Between 2013 and 2020, the age-adjusted stroke incidence rate increased in male individuals while no change was noted in female individuals. The trend observed in male individuals was driven by the increased incidence rate of arterial ischemic stroke (AIS) (yearly absolute change per 100,000 person-years: 0.14, 95% CI 0.018-0.26). The 30-day, 1-year, and 5-year cumulative mortality risks were 7.7% (95% CI 4.2-11.2), 10.0% (95% CI 6.0-13.9), and 11.0% (95% CI 6.8-15.2), respectively. Mortality risk remained stable over time (p value = 0.77). Among children alive at follow-up, moderate-severe neurologic impairment was present in 20.2% with AIS and 23.1% with intracerebral hemorrhage.
Discussion:
From 2013 through 2020, the age-adjusted incidence rate of pediatric stroke increased in male individuals while remaining stable in female individuals. Morbidity and mortality after stroke were substantial, highlighting the need for further improvements in pediatric stroke management.
