Mortality after pediatric arterial ischemic stroke

International Pediatric Stroke Study Investigators

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.

Original languageEnglish (US)
Article numbere20174146
JournalPediatrics
Volume141
Issue number5
DOIs
StatePublished - May 1 2018

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Stroke
Pediatrics
Hospital Mortality
Mortality
Odds Ratio
Confidence Intervals
Newborn Infant
Cause of Death
Heart Diseases
Hispanic Americans
Registries
Seizures
Hospitalization
Cerebrovascular Disorders
Child Mortality
Medical Records
Logistic Models

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

International Pediatric Stroke Study Investigators (2018). Mortality after pediatric arterial ischemic stroke. Pediatrics, 141(5), [e20174146]. https://doi.org/10.1542/peds.2017-4146

Mortality after pediatric arterial ischemic stroke. / International Pediatric Stroke Study Investigators.

In: Pediatrics, Vol. 141, No. 5, e20174146, 01.05.2018.

Research output: Contribution to journalArticle

International Pediatric Stroke Study Investigators 2018, 'Mortality after pediatric arterial ischemic stroke', Pediatrics, vol. 141, no. 5, e20174146. https://doi.org/10.1542/peds.2017-4146
International Pediatric Stroke Study Investigators. Mortality after pediatric arterial ischemic stroke. Pediatrics. 2018 May 1;141(5). e20174146. https://doi.org/10.1542/peds.2017-4146
International Pediatric Stroke Study Investigators. / Mortality after pediatric arterial ischemic stroke. In: Pediatrics. 2018 ; Vol. 141, No. 5.
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title = "Mortality after pediatric arterial ischemic stroke",
abstract = "OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5{\%}) and 70 of 2273 children (3.1{\%}) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6{\%}) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95{\%} confidence interval [CI]: 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95{\%} CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95{\%} CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95{\%} CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95{\%} CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95{\%} CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6{\%} of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.",
author = "{International Pediatric Stroke Study Investigators} and Beslow, {Lauren A.} and Dowling, {Michael M.} and Hassanein, {Sahar M.A.} and Lynch, {John K.} and Dimitrios Zafeiriou and Sun, {Lisa R.} and Ilona Kopyta and Luigi Titomanlio and Anneli Kolk and Anthony Chan and Jose Biller and Grabowski, {Eric F.} and Abdalla, {Abdalla A.} and Mackay, {Mark T.} and Gabrielle DeVeber and Steve Ashwal and Donna Ferriero and Heather Fullerton and Rebecca Ichord and Fenella Kirkham and Finbar O'Callaghan and Steve Pavlakis and Guillaume Sebire and Andrew Willan and Adam Kirton and Neil Goldenberg and Montri Saengpattrachai and Hal Crosswell and Michael Rivkin and Bruce Bjornson and Nana Tatishvili and Vesna Brankovic-Sreckovic and Timothy Bernard and Jennifer Armstrong and Peter Humphreys and Geoffrey Heyer and Robert Fryer and Ann Yeh and Lori Billinghurst and Chaouki Khoury and Lisa Abraham and Harry Whelan and Ulrike Nowak-Gottl and Mark Wainwright and John Condie and Jessica Carpenter and Susanne Holzhauer and Yang Guang and Zou, {Li Ping} and Carter Wray",
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TY - JOUR

T1 - Mortality after pediatric arterial ischemic stroke

AU - International Pediatric Stroke Study Investigators

AU - Beslow, Lauren A.

AU - Dowling, Michael M.

AU - Hassanein, Sahar M.A.

AU - Lynch, John K.

AU - Zafeiriou, Dimitrios

AU - Sun, Lisa R.

AU - Kopyta, Ilona

AU - Titomanlio, Luigi

AU - Kolk, Anneli

AU - Chan, Anthony

AU - Biller, Jose

AU - Grabowski, Eric F.

AU - Abdalla, Abdalla A.

AU - Mackay, Mark T.

AU - DeVeber, Gabrielle

AU - Ashwal, Steve

AU - Ferriero, Donna

AU - Fullerton, Heather

AU - Ichord, Rebecca

AU - Kirkham, Fenella

AU - O'Callaghan, Finbar

AU - Pavlakis, Steve

AU - Sebire, Guillaume

AU - Willan, Andrew

AU - Kirton, Adam

AU - Goldenberg, Neil

AU - Saengpattrachai, Montri

AU - Crosswell, Hal

AU - Rivkin, Michael

AU - Bjornson, Bruce

AU - Tatishvili, Nana

AU - Brankovic-Sreckovic, Vesna

AU - Bernard, Timothy

AU - Armstrong, Jennifer

AU - Humphreys, Peter

AU - Heyer, Geoffrey

AU - Fryer, Robert

AU - Yeh, Ann

AU - Billinghurst, Lori

AU - Khoury, Chaouki

AU - Abraham, Lisa

AU - Whelan, Harry

AU - Nowak-Gottl, Ulrike

AU - Wainwright, Mark

AU - Condie, John

AU - Carpenter, Jessica

AU - Holzhauer, Susanne

AU - Guang, Yang

AU - Zou, Li Ping

AU - Wray, Carter

PY - 2018/5/1

Y1 - 2018/5/1

N2 - OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.

AB - OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [CI]: 1.23-12.29; P = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; P = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; P = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; P = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; P < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; P = .003) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.

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