Understanding in-hospital mortality after stroke in pediatric patients
1. The rate of in-hospital mortality after arterial ischemic stroke (AIS) in pediatric patients was shown to be about 2.6%.
2. Post-stroke mortality in pediatrics were most frequently due to the strokes themselves, while risk factors for mortality after stroke included congenital heart disease and strokes that involve both anterior and posterior circulation.
Evidence Rating Level: 2 (Good)
Study Rundown: While strokes are uncommon in children compared to adults, they are among the top 10 causes of death for children in the US. Authors of this study examined cases of AIS in pediatric patients logged in a multi-national registry over 11 years to evaluate the risk factors specific to in-hospital mortality associated with AIS in children and neonates. Findings suggested that the rate of in-hospital mortality after pediatric stroke was 1.5% for neonates and 3.1% in children/adolescents. The authors also found that the strongest risk factors for mortality were congenital heart disease and stroke that involved both anterior and posterior circulation. Further, Hispanic ethnicity was found to be associated with mortality in non-neonate children. The study included a broad multinational cohort but was limited by lack of data about specific causes of death or specific congenital heart defects associated with mortality. Nonetheless, these results highlight the risk factors associated with in-hospital mortality after stroke in children; awareness of these risk factors may increase opportunities for management and survival.
In-Depth [prospective cohort]: This multinational cohort study enrolled 915 neonates (age <1 year) and 2273 children (median age 5.7 years, range: 1.6-2.3) from 24 countries. The average yearly in-hospital mortality was 2.7 per 100 stroke admissions. While children were more likely to die than neonates (OR: 2.04, 95% CI: 1.15-3.65), increasing age in childhood showed no increased risk of death. In multivariable analysis of risk factors in neonates, congenital heart disease (OR: 3.88, 95% CI: 1.23-12.22), posterior plus anterior stroke presentation (OR: 5.36, 95% CI: 1.70-16.85), and presentation without seizure (OR: 3.95, 95% CI: 1.26-12.37) were associated with in-hospital mortality. In children, congenital heart disease (OR: 3.14, 95% CI: 1.75-5.61), posterior plus anterior stroke presentation (OR: 2.71, 95% CI: 1.40-5.25), and Hispanic ethnicity (OR: 3.12, 95% CI: 1.56-6.24) were associated with in-hospital mortality. Cause of death was available in 64.3% (9/14) of neonates and 55.7% (39/70) of children that died. In the 48 total cases with reported causes of death, stroke was attributed as the cause of death in 64.6% (31/48) cases, with the remainder attributed to medical disease.
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