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The International Pediatric Stroke Study: Insight into Childhood Stroke from a Developmental Perspective
Michael J Rivkin1, Alexandra Linds2, Mahmoud Slim2
1Stroke and Cerebrovascular Center, Dept. of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Insights
Pediatric stroke characteristics vary significantly by age and stroke type. The International Pediatric Stroke Study (IPSS) database reveals distinct features in neonates, infants, young children, and adolescents, aiding in stroke recognition and understanding pathophysiology.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Epidemiology
Background:
- The International Pediatric Stroke Study (IPSS) database is a crucial resource for understanding childhood stroke.
- Pediatric stroke encompasses a wide age range, from neonates to adolescents, with diverse underlying causes and presentations.
- Limited data exists on how stroke characteristics vary across different developmental stages in children.
Purpose of the Study:
- To analyze the demographic, clinical, radiographic, and therapeutic features of pediatric stroke patients within the IPSS database.
- To identify age- and development-related characteristics associated with stroke occurrence in children.
- To stratify patients into distinct age groups to better understand developmental influences on stroke.
Main Methods:
- Utilized data from the International Pediatric Stroke Study (IPSS) database, including 4,294 patients enrolled between 2003 and 2014.
- Stratified children into four age groups: neonates (0-28 days), infants (29 days to <2 years), young children (2 to <10 years), and adolescents (>10 to <18 years).
- Employed standardized case report forms and statistical analyses (SAS) to examine continuous and categorical variables.
Main Results:
- Analyzed data from 3,809 children, with representation across all four age strata.
- Identified distinct clinical and neuroimaging features that differentiate arterial ischemic stroke from cerebral sinus venous thrombosis within each age group.
- Reported age-specific patterns for both stroke types, highlighting differences in neonates versus older children.
Conclusions:
- The IPSS database provides a robust foundation for advancing pediatric stroke research.
- Developmentally informed analysis of IPSS data reveals age-specific stroke features that are critical for understanding pathophysiology.
- Recognizing these age-related patterns can improve the clinical diagnosis and management of pediatric stroke.
Objective:
To determine if children enrolled in the International Pediatric Stroke Study (IPSS) database (4294 patients enrolled, 2003-2014, neonates through 18 years of age) demonstrate demographic, clinical, radiographic, and therapeutic characteristics that relate to age and development at the time of stroke.
Study Design:
Participants with arterial ischemic stroke or cerebral sinus venous thrombosis were enrolled using standardized consent and case report forms. Data were entered on-site and electronically transferred to a central data storage site in Toronto, Canada. Children were stratified into 4 age groups for analysis of developmental features: neonates (0-28 days of age); infants (29 days to <2 years of age); young children (2 years to <10 years old), and adolescents (≥10 years to <18 years old). Continuous and categorical variables were examined using appropriate statistical techniques in SAS (SAS Institute, Inc).
Results:
Three thousand eight-hundred nine children were analyzed: 1112 (29.2%) neonates, 728 (19.1%) infants, 1088 (28.6%) young children, and 881 (23.1%) adolescents. Arterial ischemic stroke alone occurred in 3201 (916 neonates; 2285 older children) and cerebral sinovenous thrombosis alone occurred in 608 (196 neonates; 412 older children). Age group specific clinical and neuroimaging features that segregate by ischemic stroke type were identified and are reported.
Conclusions:
The IPSS database comprises a very large, structured pediatric stroke database used by investigators to advance the understanding and treatment of pediatric stroke. Developmentally based analyses of IPSS data reveal features of childhood stroke that segregate by ischemic stroke type and age at stroke occurrence. These features should aid in understanding age-related pathophysiology and in clinical stroke recognition.
