Top

Journal of Neurology

Published in:

01-06-2019 | Stroke | Original Communication

Risk factors for in-hospital and follow-up mortality after childhood arterial ischemic stroke

Authors: Mauricio Lopez-Espejo, Marta Hernandez-Chavez, Isidro Huete

Published in: Journal of Neurology | Issue 6/2019

Abstract

Objectives

To explore risk factors contributing to 30-day and long-term survival in children with a first episode of arterial ischemic stroke (AIS).

Study design

Single center prospective observational study including 119 children aged between 30 days and 18 years, with a first episode of AIS between 2003 and 2015. Diagnosis was confirmed with magnetic resonance images. Outcomes included 30-day mortality and survival up to 8 years of follow-up. Demographic (e.g., gender, age), clinical (e.g., stroke severity measured by the Pediatric National Institute of Health Stroke Scale (NIHSS), clinical presentation, underlying conditions), radiological (e.g., involved circulation, location), and stroke recurrence data, were used to predict outcomes. Data analyses included logistic and Cox regression multivariate models with Firth’s bias correction.

Results

30-day mortality was 11.7% (n = 14). A total of 23 (19.3%) children died during the follow-up. 30-day mortality was only predicted by stroke severity (OR = 1.11, 95% CI = 1.02–1.26) in children > 2 years. Survival was predicted by stroke severity (HR = 1.05, 95% CI = 1.01–1.09), congenital heart disease (HR = 3.62, 95% CI = 1.33–10.93), prothrombotic states (HR = 3.51, 95% CI = 1.25–9.32), and anterior plus posterior circulation stroke (HR = 2.43, 95% CI = 1.42–4.61, p 0.026). Stroke recurrence (n= 23; 19.3%) was not a significant predictor of follow-up mortality.

Conclusions

This study identified groups with greater acute and long-term mortality after a first episode of AIS in childhood. Specific interventions focused on these risk groups may decrease mortality rates. Further studies need to confirm our findings by adding children from other centers.

Agrawal N, Johnston SC, Wu YW, Sidney S, Fullerton HJ (2009) Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke 40(11):3415–3421CrossRefPubMedPubMedCentral

Giroud M, Lemesle M, Gouyon JB, Nivelon JL, Milan C, Dumas R (1995) Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: a study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol 48(11):1343–1348CrossRefPubMed

Mallick AA, Ganesan V, Kirkham FJ, Fallon P, Hedderly T, McShane T et al (2014) Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol 13(1):35–43CrossRefPubMed

Fullerton HJ, Wu YW, Zhao S, Johnston SC (2003) Risk of stroke in children: ethnic and gender disparities. Neurology 61(2):189–194CrossRefPubMed

MacKay MT, Wiznitzer M, Benedict SL, Lee KJ, deVeber GA, Ganesan V et al (2011) Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol 69(1):130–140CrossRefPubMed

Greenham M, Gordon A, Anderson V, MacKay MT (2016) Outcome in childhood stroke. Stroke 47(4):1159–1164CrossRefPubMed

Fullerton HJ, Chetkovich DM, Wu YW, Smith WS, Johnston SC (2002) Deaths from stroke in US children, 1979 to 1998. Neurology 59(1):34–39CrossRefPubMed

Krishnamurthi RV, deVeber GA, Feigin VL, Barker-Collo S, Fullerton H, Mackay MT, et al. Stroke Panel Experts Group. Stroke prevalence, mortality and disability-adjusted life years in children and youth aged 0–19 years: data from the global and regional burden of stroke 2013. Neuroepidemiology 2015;45(3):177–89.CrossRef

Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al (2009) Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486CrossRef

10.

Beslow LA, Dowling MM, Hassanein SMA, Lynch JK, Zafeiriou D, Sun LR et al (2018) Mortality after pediatric arterial ischemic stroke. Pediatrics 141(5):e20174146CrossRefPubMed

11.

Lopez-Espejo M, Hernandez-Chavez M (2017) Prevalence and predictors of long-term functional impairment, epilepsy, mortality, and stroke recurrence after childhood stroke: a prospective study of a Chilean cohort. J Stroke Cerebrovasc Dis 26(7):1646–1652CrossRefPubMed

12.

Ichord RN, Bastian R, Abraham L, Askalan R, Benedict S, Bernard TJ et al (2011) Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke 42(3):613–617CrossRefPubMedPubMedCentral

13.

Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW et al (2010) Recommendation for a definition of acute symptomatic seizure. Epilepsia 51(4):671–675CrossRefPubMed

14.

López-Espejo M, Hernández-Chávez M, Huete I (2018) Clinical and radiological risk factors for poststroke epilepsy in childhood. Epilepsy Behav 2018(88):113–116CrossRef

15.

Chiang KL, Cheng CY (2018) Epidemiology, risk factors and characteristics of pediatric stroke: a nationwide population-based study. QJM 111(7):445–454CrossRefPubMed

16.

Adil MM, Qureshi AI, Beslow LA, Malik AA, Jordan LC (2015) Factors associated with increased in-hospital mortality among children with intracerebral hemorrhage. J Child Neurol. 30(8):1024–1028CrossRefPubMed

17.

Yang Q, Tong X, Schieb L, Vaughan A, Gillespie C, Wiltz JL et al (2017) Vital signs: recent trends in stroke death rates—United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 66(35):933–939CrossRefPubMedPubMedCentral

18.

Fox CK, Johnston SC, Sidney S, Fullerton HJ (2012) High critical care usage due to pediatric stroke: results of a population-based study. Neurology 79(5):420–427CrossRefPubMedPubMedCentral

19.

Brush LN, Monagle PT, Mackay MT, Gordon AL (2013) Hypertension at time of diagnosis and long-term outcome after childhood ischemic stroke. Neurology 80(13):1225–1230CrossRefPubMed

20.

Chung B, Wong V (2004) Pediatric stroke among Hong Kong Chinese subjects. Pediatrics 114(2):e206–e212CrossRefPubMed

21.

Hankey GJ (2003) Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovasc Dis 16(Suppl1):14–19CrossRefPubMed

Title: Risk factors for in-hospital and follow-up mortality after childhood arterial ischemic stroke
Authors: Mauricio Lopez-Espejo
Marta Hernandez-Chavez
Isidro Huete
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keyword: Stroke
Published in: Journal of Neurology / Issue 6/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-019-09293-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Risk factors for in-hospital and follow-up mortality after childhood arterial ischemic stroke

Abstract

Objectives

Study design

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Study design

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2019

Congenital myopathies are mainly associated with a mild cardiac phenotype

Triple and quadruple cervical artery dissections: a systematic review of individual patient data

What is the role of the cerebellum in the pathophysiology of dystonia?

Screening of SLC2A1 in a large cohort of patients suspected for Glut1 deficiency syndrome: identification of novel variants and associated phenotypes

Update on opsoclonus–myoclonus syndrome in adults

Gerald M. Edelman (1929–2014)