Epidemiology and Outcomes of Arterial Ischemic Stroke in Children: The Canadian Pediatric Ischemic Stroke Registry
| Autor: | E. Athen MacDonald, Michael Shevell, Peter Humphreys, Ellen Wood, Adam Kirton, Bernard Lemieux, Brandon F. Meaney, David Buckley, Lawrence Jardine, Jerome Y. Yager, Anthony K.C. Chan, Frances A. Booth, Daune MacGregor, Ann Marie Surmava, Patricia McCusker, Bruce Bjornson, Gabrielle deVeber, Michèle David, M. Patricia Massicotte, Elaine C. Wirrell, Simon Levin |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Canada Adolescent Population Kaplan-Meier Estimate Brain Ischemia 03 medical and health sciences 0302 clinical medicine Developmental Neuroscience Risk Factors 030225 pediatrics Acute care Epidemiology medicine Humans Prospective Studies Registries education Child Preschool Stroke education.field_of_study business.industry Clinical study design Incidence Infant Newborn Infant medicine.disease Newborn Arterial Ischemic Stroke Clinical trial Treatment Outcome Neurology Child Preschool Pediatrics Perinatology and Child Health Ischemic stroke Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Paediatrics Publications |
| Popis: | BACKGROUND: Pediatric arterial ischemic stroke remains incompletely understood. Population-based epidemiological data inform clinical trial design but are scant in this condition. We aimed to determine age-specific epidemiological characteristics of arterial ischemic stroke in neonates (birth to 28 days) and older children (29 days to 18 years). METHODS: We conducted a 16-year, prospective, national population-based study, the Canadian Pediatric Ischemic Stroke Registry, across all 16 Canadian acute care children's hospitals. We prospectively enrolled children with arterial ischemic stroke from January 1992 to December 2001 and documented disease incidence, presentations, risk factors, and treatments. Study outcomes were assessed throughout 2008, including abnormal clinical outcomes (stroke-related death or neurological deficit) and recurrent arterial ischemic stroke or transient ischemic attack. RESULTS: Among 1129 children enrolled with arterial ischemic stroke, stroke incidence was 1.72/100,000/year, (neonates 10.2/100,000 live births). Detailed clinical and radiological information were available for 933 children (232 neonates and 701 older children, 55% male). The predominant clinical presentations were seizures in neonates (88%), focal deficits in older children (77%), and diffuse neurological signs (54%) in both. Among neonates, 44% had no discernible risk factors. In older children, arteriopathy (49% of patients with vascular imaging), cardiac disorders (28%), and prothrombotic disorders (35% of patients tested) predominated. Antithrombotic treatment increased during the study period (P < 0.001). Stroke-specific mortality was 5%. Outcomes included neurological deficits in 60% of neonates and 70% of older children. Among neonates, deficits emerged during follow-up in 39%. Overall, an initially decreased level of consciousness, a nonspecific systemic presentation, and the presence of stroke risk factors predicted abnormal outcomes. For neonates, predictors were decreased level of consciousness, nonspecific systemic presentation, and basal ganglia infarcts. For older children, predictors were initial seizures, nonspecific systemic presentation, risk factors, and lack of antithrombotic treatment. Recurrent arterial ischemic stroke or transient ischemic attack developed in 12% of older children and was predicted by arteriopathy, presentation without seizures, and lack of antithrombotic treatment. Emerging deficit was predicted by neonatal age at stroke and by cardiac disease. CONCLUSIONS: This national data set provides a population-based disease incidence rate and demonstrates the protective effect of antithrombotic treatment in older children, and frequent long-term emerging deficits in neonates and in children with cardiac disorders. Further clinical trials are required to develop effective age-appropriate treatments for children with acute arterial ischemic stroke. |
| Databáze: | OpenAIRE |
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