Congenital Heart Disease, Hispanic Ethnicity Associated With Increased Mortality in Pediatric Arterial Ischemic Stroke

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Posterior plus anterior circulation stroke and congenital heart disease were highly associated with in-hospital mortality in pediatric arterial ischemic stroke.
Posterior plus anterior circulation stroke and congenital heart disease were highly associated with in-hospital mortality in pediatric arterial ischemic stroke.

A study published in Pediatrics shows that the risks for in-hospital mortality in pediatric patients with arterial ischemic stroke (AIS) are highest among those with posterior plus anterior circulation stroke and congenital heart disease. Additional risk factors associated with in-hospital mortality in neonates and children with AIS include the absence of seizures on presentation and Hispanic ethnicity, respectively.

In this retrospective analysis of the International Pediatric Stroke Study, investigators enrolled 915 neonates (age, 0-28 days) and 2273 children (age, 29 days to <19 years) with AIS. Medical records were evaluated to determine rates of in-hospital mortality and causes of mortality between 2003 and 2014, with investigators subsequently identifying risk factors for in-hospital mortality in this patient population.

During hospitalization, 1.5% and 3.1% of neonates and children died, respectively. A majority of deaths were attributed to stroke or stroke plus other medical causes (64.6%). In neonate participants, the risk factors for in-hospital mortality were congenital heart disease (odds ratio [OR], 3.88; 95% 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).

In addition, the risk factors for mortality during hospitalization in children included 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).

Limitations of this analysis include the investigators' inability to determine which type of congenital heart disease or which type of ventricular assist device, if used, played a role in mortality outcomes.

Practicing physicians "who care for pediatric patients with AIS may use the information in this report to aid recognition of those who may be at high risk for deterioration and death."

Reference

Beslow LA, Dowling MM, Hassanein SMA, et al; for the International Pediatric Stroke Study Investigators. Mortality after pediatric arterial ischemic stroke. Pediatrics. 2018;141(5):e20174146.

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