Cardiovascular and Hematological Risk Factors and Mortality Risk in Pediatric Arterial Ischemic Stroke: Analysis Report From Hospitals in the United States

Beriwal, Nitya; Imran, Hira; Okotcha, Edmond; Oraka, Kosisochukwu; Kataria, Saurabh; Bhandari, Renu; Patel, Rikinkumar S

doi:10.7759/cureus.10859

Cited by 2 publications

(4 citation statements)

References 19 publications

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“…In-hospital mortality rate in childhood stroke has been reported with large variations, with a trend of the larger studies reporting lower mortality rates. Two relatively large cohorts present an in-hospital mortality of 3.1%-3.6% 75,77 whilst a 30-day mortality of almost 12% was seen in a single center Chilean study of 119 children. 76 The Canadian pediatric ischemic stroke register study showed a stroke specific mortality of 5% for pediatric ischemic stroke.…”

Section: Childhood Ischemic Strokementioning

confidence: 98%

“…Mortality after pediatric ischemic stroke is assessed in a handful studies as the main research question. [72][73][74][75][76][77] Most studies evaluate hemorrhagic as well as ischemic stroke and include both perinatal and childhood cases. National register data from the United States used death certificates in children up to 20 years of age and showed a mortality rate of 0.09 per 100 000 person-years.…”

Section: Mortalitymentioning

confidence: 99%

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Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

Walås

2023

Linköping University Medical Dissertations

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Pediatric ischemic stroke is divided into perinatal stroke, 20 weeks gestation until the 28 th day of life, and childhood stroke, the 29 th day of life until 18 years of age. Perinatal and childhood stroke differ in risk factors and outcomes but both cause increased mortality and morbidity in the pediatric population. The overall aim of this thesis was to identify factors associated with risk of pediatric ischemic stroke or, risk of adverse outcome and morbidity after pediatric ischemic stroke, in a validated cohort.This thesis consists of four register-based epidemiological studies. First, a validation study of pediatric ischemic stroke diagnoses (International classification of diseases [ICD]-10: I63, I64; 434, 436) in children 1969-2016. Through medical chart review, we validated the diagnoses of pediatric ischemic stroke and found a positive predictive value of 89% (95% CI 0.85-0.92) in the Swedish National Patient Register. About 2/3 of the ischemic stroke cases were identified in the later years (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016), during which 98% of the diagnoses were confirmed by radiology. Second, a matched cohort study of long-term mortality after pediatric ischemic stroke showed that mortality was elevated over 20 years after the stroke, without difference between perinatal and childhood stroke. Mortality risk was also elevated in first-degree relatives of individuals with childhood stroke. Third, a matched cohort study showed that 32% (280 of 877) of the children with ischemic stroke were diagnosed with adverse motor outcome (i.e., cerebral palsy or hemiparesis). The risk of adverse motor outcome was higher after ischemic stroke in childhood compared to the perinatal period, but neither male sex, low gestational age nor high parental age showed any association. Fourth, a cohort study of all births in Sweden 1998-2019 assessed maternal body mass index (BMI) as a risk factor for perinatal ischemic stroke. In mothers with obesity (BMI >30) the risk of perinatal ischemic stroke in the infant increased two-fold.Pediatric ischemic stroke has a high positive predictive value in the National Patient Register, enabling high-quality register-based research using these diagnoses. Limitation to later years (>1997) give higher identification rate, with almost complete confirmation by radiology. Although there was no difference in long-term mortality risk between childhood and perinatal ischemic stroke, the underlying mechanisms are diverse. The analysis of the cause-specific mortality could indicate factors relevant to the risk of mortality after pediatric ischemic stroke. Adverse motor outcome is common after pediatric ischemic stroke, especially in childhood. The ICD codes My warmest gratitude towards all who have contributed throughout my PhD studies and in the writing of this thesis.To my supervisors Heléne Sundelin, Peter Bang, and Jenny Bolk for guiding me through the process. Heléne, for momentum and contagious love for...

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Section: Childhood Ischemic Strokementioning

confidence: 98%

Section: Mortalitymentioning

confidence: 99%

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

Walås

2023

Linköping University Medical Dissertations

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“…8 Finally, we are unaware of any mortality studies in relatives of individuals with pediatric ischemic stroke despite that many risk factors for pediatric stroke and mortality thereafter have a hereditary component. 3,9 For these reasons, we performed a nationwide cohort study of >1600 children with stroke and their first-degree relatives to estimate overall and cause-specific mortality.…”

mentioning

confidence: 99%

“…Finally, we are unaware of any mortality studies in relatives of individuals with pediatric ischemic stroke despite that many risk factors for pediatric stroke and mortality thereafter have a hereditary component. 3,9…”

mentioning

confidence: 99%

Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study

Sundelin

Walas

Söderling

et al. 2022

Stroke

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Background and Purpose: Ischemic stroke is a common cause of death in adults, however, mortality after pediatric ischemic stroke is not well explored. We investigate long-term and cause-specific mortality in children with ischemic stroke and their first-degree relatives. Methods: Through nationwide Swedish registers, we identified 1606 individuals <18 years old with ischemic stroke between 1969 and 2016 and their first-degree relatives (n=5714). Each individual with ischemic stroke was compared with 10 reference individuals (controls) matched for age, sex, and county of residence. Our main analysis examined 1327 children with ischemic stroke still alive 1 week after the event. First-degree relatives to children with ischemic stroke were compared with first-degree relatives to the reference individuals. Using a Cox proportional hazard regression model, the risk of overall and cause-specific mortality was computed in individuals with pediatric ischemic stroke and their first-degree relatives. Results: The mortality rate in the first 6 months was 40.1 (95% CI, 24.7–55.6) per 1000 person-years compared with 1.1/1000 in controls (95% CI, 0.3–1.9). The overall mortality risk was hazard ratio (HR)=10.8 (95% CI, 8.1–14.3) and remained elevated beyond 20 years (HR=3.9 [95% CI, 2.1–7.1]). Children with ischemic stroke were at increased risk of death from neurological diseases (HR=29.9 [95% CI, 12.7–70.3]), cardiovascular diseases (HR=6.2 [95% CI, 1.8–22.2]), cancers (HR=6.5 [95% CI, 2.6–15.9]) and endocrine, nutritional and metabolic diseases (HR=49.2 [95% CI, 5.7–420.8]). First-degree relatives to children with ischemic stroke had an increased mortality risk (HR=1.21 [95% CI, 1.05–1.39]), with the highest risk among siblings (HR=1.52 [95% CI, 1.09–2.11]) and relatives to individuals with ischemic stroke >28 days of age (HR=1.23 [95% CI, 1.06–1.42]) compared with the relatives of the controls. Conclusions: Long-term mortality increased after pediatric ischemic stroke, even 20 years later, with neurological diseases as the most frequent cause of death.

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Cardiovascular and Hematological Risk Factors and Mortality Risk in Pediatric Arterial Ischemic Stroke: Analysis Report From Hospitals in the United States

Cited by 2 publications

References 19 publications

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

Pediatric ischemic stroke : Epidemiological aspects of validity, risk factors, and outcomes

Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study

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