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Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study

Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study
Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study

BACKGROUND: Arterial ischaemic stroke is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood arterial ischaemic stroke have been undertaken. We aimed to investigate the epidemiology and clinical features of childhood arterial ischaemic stroke in a population-based cohort.

METHODS: Children aged 29 days to less than 16 years with radiologically confirmed arterial ischaemic stroke occurring over a 1-year period (July 1, 2008, to June 30, 2009) residing in southern England (population denominator 5·99 million children) were eligible for inclusion. Cases were identified using several sources (paediatric neurologists and trainees, the British Paediatric Neurology Surveillance Unit, paediatricians, radiologists, physiotherapists, neurosurgeons, parents, and the Paediatric Intensive Care Audit Network). Cases were confirmed by personal examination of cases and case notes. Details of presenting features, risk factors, and investigations for risk factors were recorded by analysis of case notes. Capture-recapture analysis was used to estimate completeness of ascertainment.

FINDINGS: We identified 96 cases of arterial ischaemic stroke. The crude incidence of childhood arterial ischaemic stroke was 1·60 per 100 000 per year (95% CI 1·30-1·96). Capture-recapture analysis suggested that case ascertainment was 89% (95% CI 77-97) complete. The incidence of arterial ischaemic stroke was highest in children aged under 1 year (4·14 per 100 000 per year, 95% CI 2·36-6·72). There was no difference in the risk of arterial ischaemic stroke between sexes (crude incidence 1·60 per 100 000 per year [95% CI 1·18-2·12] for boys and 1·61 per 100 000 per year [1·18-2·14] for girls). Asian (relative risk 2·14, 95% CI 1·11-3·85; p=0·017) and black (2·28, 1·00-4·60; p=0·034) children were at higher risk of arterial ischaemic stroke than were white children. 82 (85%) children had focal features (most commonly hemiparesis) at presentation. Seizures were more common in younger children (≤1 year) and headache was more common in older children (>5 years; p<0·0001). At least one risk factor for childhood arterial ischaemic stroke was identified in 80 (83%) cases.

INTERPRETATION: Age and racial group, but not sex, affected the risk of arterial ischaemic stroke in children. Investigation of such differences might provide causative insights.

FUNDING: The Stroke Association, UK.

Adolescent, Brain Ischemia, Child, Child, Preschool, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Population Surveillance, Prospective Studies, Risk Factors, Stroke, Journal Article, Observational Study, Research Support, Non-U.S. Gov't
1474-4422
35-43
Mallick, Andrew A.
97c8dd33-55de-41e8-9c2f-07f0883ef56c
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Fallon, Penny
448d79fe-cdb4-427f-aa50-492760899806
Hedderly, Tammy
05752dfa-7fae-47b0-bbfb-606185ea008b
McShane, Tony
8624e37b-473c-4803-94af-845dd3467faa
Parker, Alasdair P
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Wassmer, Evangeline
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Wraige, Elizabeth
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Amin, Samir
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Edwards, Hannah B
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Tilling, Kate
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O'Callaghan, Finbar J.
ac13f6d9-2bc3-4499-a1d9-e0911137b5fb
Mallick, Andrew A.
97c8dd33-55de-41e8-9c2f-07f0883ef56c
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Fallon, Penny
448d79fe-cdb4-427f-aa50-492760899806
Hedderly, Tammy
05752dfa-7fae-47b0-bbfb-606185ea008b
McShane, Tony
8624e37b-473c-4803-94af-845dd3467faa
Parker, Alasdair P
03f88b2b-62a6-42ba-b4fe-1f7279d469e0
Wassmer, Evangeline
9ce66ff0-5bbf-4f56-ad31-07501c1f3347
Wraige, Elizabeth
6dc4ee2a-a0ba-44c2-996a-5b631d4c7beb
Amin, Samir
7230de72-6a71-4e51-ad8a-3a2ff12dea96
Edwards, Hannah B
d7cf00e7-dd66-41d5-a847-7b8a3ee5d5d6
Tilling, Kate
016f1a6c-9568-4211-84d4-019f2c1d7b38
O'Callaghan, Finbar J.
ac13f6d9-2bc3-4499-a1d9-e0911137b5fb

Mallick, Andrew A., Ganesan, Vijeya, Kirkham, Fenella J., Fallon, Penny, Hedderly, Tammy, McShane, Tony, Parker, Alasdair P, Wassmer, Evangeline, Wraige, Elizabeth, Amin, Samir, Edwards, Hannah B, Tilling, Kate and O'Callaghan, Finbar J. (2014) Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. The Lancet Neurology, 13 (1), 35-43. (doi:10.1016/S1474-4422(13)70290-4).

Record type: Article

Abstract

BACKGROUND: Arterial ischaemic stroke is an important cause of acquired brain injury in children. Few prospective population-based studies of childhood arterial ischaemic stroke have been undertaken. We aimed to investigate the epidemiology and clinical features of childhood arterial ischaemic stroke in a population-based cohort.

METHODS: Children aged 29 days to less than 16 years with radiologically confirmed arterial ischaemic stroke occurring over a 1-year period (July 1, 2008, to June 30, 2009) residing in southern England (population denominator 5·99 million children) were eligible for inclusion. Cases were identified using several sources (paediatric neurologists and trainees, the British Paediatric Neurology Surveillance Unit, paediatricians, radiologists, physiotherapists, neurosurgeons, parents, and the Paediatric Intensive Care Audit Network). Cases were confirmed by personal examination of cases and case notes. Details of presenting features, risk factors, and investigations for risk factors were recorded by analysis of case notes. Capture-recapture analysis was used to estimate completeness of ascertainment.

FINDINGS: We identified 96 cases of arterial ischaemic stroke. The crude incidence of childhood arterial ischaemic stroke was 1·60 per 100 000 per year (95% CI 1·30-1·96). Capture-recapture analysis suggested that case ascertainment was 89% (95% CI 77-97) complete. The incidence of arterial ischaemic stroke was highest in children aged under 1 year (4·14 per 100 000 per year, 95% CI 2·36-6·72). There was no difference in the risk of arterial ischaemic stroke between sexes (crude incidence 1·60 per 100 000 per year [95% CI 1·18-2·12] for boys and 1·61 per 100 000 per year [1·18-2·14] for girls). Asian (relative risk 2·14, 95% CI 1·11-3·85; p=0·017) and black (2·28, 1·00-4·60; p=0·034) children were at higher risk of arterial ischaemic stroke than were white children. 82 (85%) children had focal features (most commonly hemiparesis) at presentation. Seizures were more common in younger children (≤1 year) and headache was more common in older children (>5 years; p<0·0001). At least one risk factor for childhood arterial ischaemic stroke was identified in 80 (83%) cases.

INTERPRETATION: Age and racial group, but not sex, affected the risk of arterial ischaemic stroke in children. Investigation of such differences might provide causative insights.

FUNDING: The Stroke Association, UK.

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More information

Accepted/In Press date: 1 November 2013
e-pub ahead of print date: 2 December 2013
Published date: January 2014
Additional Information: Copyright © 2014 Elsevier Ltd. All rights reserved.
Keywords: Adolescent, Brain Ischemia, Child, Child, Preschool, Female, Humans, Incidence, Infant, Infant, Newborn, Male, Population Surveillance, Prospective Studies, Risk Factors, Stroke, Journal Article, Observational Study, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 420592
URI: https://eprints.soton.ac.uk/id/eprint/420592
ISSN: 1474-4422
PURE UUID: e525ab35-ef3a-4a0e-b399-793eada76c0c
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 10 May 2018 16:30
Last modified: 12 Nov 2019 01:51

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Contributors

Author: Andrew A. Mallick
Author: Vijeya Ganesan
Author: Fenella J. Kirkham ORCID iD
Author: Penny Fallon
Author: Tammy Hedderly
Author: Tony McShane
Author: Alasdair P Parker
Author: Evangeline Wassmer
Author: Elizabeth Wraige
Author: Samir Amin
Author: Hannah B Edwards
Author: Kate Tilling
Author: Finbar J. O'Callaghan

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