Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18.

Autor:	Kaur N; Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA., Patel S; Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA., Ayanbadejo MO; Neuroscience Service line, Mercy Hospital, Buffalo, NY, USA., Hoffman H; Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA., Akano E; Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA., Anikpezie N; Department of Population Health, University of Mississippi, Jackson, MS, USA., Aneni E; Department of Cardiology, Yale University, New Haven, CT, USA., Lamikanra O; Department of Critical Care, Springfield Clinic, Springfield, IL, USA., Wee C; Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA., Albright K; Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA., Khandelwal P; Departments of Neurology and Neurosurgery, Rutgers University New Jersey, Newark, NJ, USA., Latorre JG; Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA., Chaturvedi S; Department of Neurology, University of Maryland, Baltimore, MD, USA., Otite FO; Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2023 Apr; Vol. 18 (4), pp. 469-476. Date of Electronic Publication: 2022 Oct 15.
DOI:	10.1177/17474930221127538
Abstrakt:	Objectives: To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States. Methods: We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009-2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment. Results: From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15-17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5-9 years: 3.1%, 15-17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1-4 years: 0.9% and 15-17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value =  0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10-14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15-17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren's hospitals (both p values < 0.05) but usage in designated children's hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status. Conclusion: IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10-17 years. Utilization increased mainly in patients hospitalized in nonchildren's hospitals. Usage in children's hospitals did not change significantly over time.
Databáze:	MEDLINE
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