The University of Southampton
×
Filter your search:
University of Southampton Institutional Repository

Mortality after pediatric arterial ischemic stroke

Mortality after pediatric arterial ischemic stroke
Mortality after pediatric arterial ischemic stroke

OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [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) were associated with in-hospital mortality for neonates. 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) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.

0031-4005
Beslow, Lauren A.
c6d2f7ce-55d6-47c4-bb01-f4f2282597b1
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Hassanein, Sahar M.A.
58b4e0de-6031-4a32-9a45-cf0ef44412ae
Lynch, John K.
2f70340f-5dc0-41e6-aa60-ffd12009af9a
Zafeiriou, Dimitrios
6311a98f-008c-4a32-a414-9b37c088d737
Sun, Lisa R.
959c6bd3-5629-4fb8-9205-59311858c0f5
Kopyta, Ilona
0d28d52f-9f9e-4aa3-aa64-f4041081d846
Titomanlio, Luigi
b542f391-814c-414b-bae1-706b5e68abb9
Kolk, Anneli
aefe8148-4590-44ba-bde2-fcdb356a969a
Chan, Anthony
0dde2424-fe77-48eb-815c-2a183806f322
Biller, Jose
7e8a708b-4d01-433d-b885-766cafeffbcd
Grabowski, Eric F.
1a761c65-cb9e-43b3-aaa9-61e81b4a3867
Abdalla, Abdalla A.
0b4d86a6-7681-43a5-9139-d13b48d0d906
Mackay, Mark T.
2504251a-9b2b-4c21-a20c-0753bbb1c799
DeVeber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Ashwal, Steve
cbb4b1c8-b6d0-4fce-90cc-cd192f95a38f
Ferriero, Donna
e25ad321-9c72-45f2-9f94-3886d8faefcb
Fullerton, Heather
367c074c-7524-4382-b6aa-9ff9fc71802f
Ichord, Rebecca
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
O'Callaghan, Finbar
83d3e40c-9c56-4de2-b7e1-f8df1567815d
Pavlakis, Steve
b206b096-4124-4b41-9e46-48edff64a050
Sebire, Guillaume
d9f9c5fe-6397-45a8-bc81-ac03b64318d6
Willan, Andrew
dedf31dd-8826-44ba-a7d3-c20f9c5d4adc
Kirton, Adam
a3240bcb-72fc-4e40-8b17-1e6440a6f5ed
Goldenberg, Neil
f1e94433-989d-4db5-8d9d-df4c590a7b4a
Saengpattrachai, Montri
d11c0410-421b-40c5-b2e1-1f6e60c71632
Crosswell, Hal
52c8f1d5-0d8f-4b8b-8030-0a774ae455ae
Rivkin, Michael
829fc1a2-f12f-427d-9766-a0eb41f87ef8
Bjornson, Bruce
419ccc06-4437-49ad-8e47-16bbc97369dd
Tatishvili, Nana
4590f625-eabf-4038-8d89-cfad0d14f2f7
Brankovic-Sreckovic, Vesna
afa35d27-6070-496c-8e3a-a66fd54272b1
Bernard, Timothy
7f3e982c-c7a4-425d-972e-bb74c1dc91cc
Armstrong, Jennifer
890d2582-788c-43c9-9175-d582228692ca
Humphreys, Peter
9c48abe6-ed60-4d1b-b33a-6a774e9921de
Heyer, Geoffrey
54a97c43-0731-4c8e-a43f-e6c0ae7ab15d
Fryer, Robert
adb9e15d-5059-4c01-ab4d-4aa33b1f3a2f
Yeh, Ann
ce683941-6783-48b7-ba29-9c2ddcfd91fb
Billinghurst, Lori
04a7efb8-8063-425c-83bf-ad9fde325472
Khoury, Chaouki
72788ee8-f77a-4037-954e-cf962315981d
Abraham, Lisa
fe469954-eca8-4a32-a215-9913270321af
Whelan, Harry
e5ef3c20-36fe-47f2-b7ac-cc0ce6c8738a
Nowak-Gottl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff
Wainwright, Mark
d1c43163-1721-4a03-9522-7a9ae0dbfa8f
Condie, John
448e0f0a-ff3b-434d-82cf-8c90233c82cd
Carpenter, Jessica
6ff59567-61cd-4185-80c3-38041e6331d6
Holzhauer, Susanne
373066b5-1a6f-40b7-9ac9-b917138d13c9
Guang, Yang
427fd530-b9d3-4f83-a9f8-b08845fecde4
Zou, Li Ping
057f3df6-5d19-4029-bc76-4f2111fb1bef
Taylor, J. Michael
70c2af40-683e-4885-9691-3bf986e8226c
International Pediatric Stroke Study Investigators
Beslow, Lauren A.
c6d2f7ce-55d6-47c4-bb01-f4f2282597b1
Dowling, Michael M.
55720e49-d317-44bd-9cc6-8cc840232fe3
Hassanein, Sahar M.A.
58b4e0de-6031-4a32-9a45-cf0ef44412ae
Lynch, John K.
2f70340f-5dc0-41e6-aa60-ffd12009af9a
Zafeiriou, Dimitrios
6311a98f-008c-4a32-a414-9b37c088d737
Sun, Lisa R.
959c6bd3-5629-4fb8-9205-59311858c0f5
Kopyta, Ilona
0d28d52f-9f9e-4aa3-aa64-f4041081d846
Titomanlio, Luigi
b542f391-814c-414b-bae1-706b5e68abb9
Kolk, Anneli
aefe8148-4590-44ba-bde2-fcdb356a969a
Chan, Anthony
0dde2424-fe77-48eb-815c-2a183806f322
Biller, Jose
7e8a708b-4d01-433d-b885-766cafeffbcd
Grabowski, Eric F.
1a761c65-cb9e-43b3-aaa9-61e81b4a3867
Abdalla, Abdalla A.
0b4d86a6-7681-43a5-9139-d13b48d0d906
Mackay, Mark T.
2504251a-9b2b-4c21-a20c-0753bbb1c799
DeVeber, Gabrielle
84ce8caa-ce30-4e50-b633-e5511c554e07
Ashwal, Steve
cbb4b1c8-b6d0-4fce-90cc-cd192f95a38f
Ferriero, Donna
e25ad321-9c72-45f2-9f94-3886d8faefcb
Fullerton, Heather
367c074c-7524-4382-b6aa-9ff9fc71802f
Ichord, Rebecca
d3cb64eb-0dab-4e05-bbb6-f0ff9bbdcea8
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
O'Callaghan, Finbar
83d3e40c-9c56-4de2-b7e1-f8df1567815d
Pavlakis, Steve
b206b096-4124-4b41-9e46-48edff64a050
Sebire, Guillaume
d9f9c5fe-6397-45a8-bc81-ac03b64318d6
Willan, Andrew
dedf31dd-8826-44ba-a7d3-c20f9c5d4adc
Kirton, Adam
a3240bcb-72fc-4e40-8b17-1e6440a6f5ed
Goldenberg, Neil
f1e94433-989d-4db5-8d9d-df4c590a7b4a
Saengpattrachai, Montri
d11c0410-421b-40c5-b2e1-1f6e60c71632
Crosswell, Hal
52c8f1d5-0d8f-4b8b-8030-0a774ae455ae
Rivkin, Michael
829fc1a2-f12f-427d-9766-a0eb41f87ef8
Bjornson, Bruce
419ccc06-4437-49ad-8e47-16bbc97369dd
Tatishvili, Nana
4590f625-eabf-4038-8d89-cfad0d14f2f7
Brankovic-Sreckovic, Vesna
afa35d27-6070-496c-8e3a-a66fd54272b1
Bernard, Timothy
7f3e982c-c7a4-425d-972e-bb74c1dc91cc
Armstrong, Jennifer
890d2582-788c-43c9-9175-d582228692ca
Humphreys, Peter
9c48abe6-ed60-4d1b-b33a-6a774e9921de
Heyer, Geoffrey
54a97c43-0731-4c8e-a43f-e6c0ae7ab15d
Fryer, Robert
adb9e15d-5059-4c01-ab4d-4aa33b1f3a2f
Yeh, Ann
ce683941-6783-48b7-ba29-9c2ddcfd91fb
Billinghurst, Lori
04a7efb8-8063-425c-83bf-ad9fde325472
Khoury, Chaouki
72788ee8-f77a-4037-954e-cf962315981d
Abraham, Lisa
fe469954-eca8-4a32-a215-9913270321af
Whelan, Harry
e5ef3c20-36fe-47f2-b7ac-cc0ce6c8738a
Nowak-Gottl, Ulrike
ccdfa168-34d8-4aeb-9f93-bd1fa432b4ff
Wainwright, Mark
d1c43163-1721-4a03-9522-7a9ae0dbfa8f
Condie, John
448e0f0a-ff3b-434d-82cf-8c90233c82cd
Carpenter, Jessica
6ff59567-61cd-4185-80c3-38041e6331d6
Holzhauer, Susanne
373066b5-1a6f-40b7-9ac9-b917138d13c9
Guang, Yang
427fd530-b9d3-4f83-a9f8-b08845fecde4
Zou, Li Ping
057f3df6-5d19-4029-bc76-4f2111fb1bef
Taylor, J. Michael
70c2af40-683e-4885-9691-3bf986e8226c

Beslow, Lauren A., Dowling, Michael M., Hassanein, Sahar M.A., Lynch, John K., Zafeiriou, Dimitrios, Sun, Lisa R., Kopyta, Ilona, Titomanlio, Luigi, Kolk, Anneli, Chan, Anthony, Biller, Jose, Grabowski, Eric F., Abdalla, Abdalla A., Mackay, Mark T., DeVeber, Gabrielle, Ashwal, Steve, Ferriero, Donna, Fullerton, Heather, Ichord, Rebecca, Kirkham, Fenella, O'Callaghan, Finbar, Pavlakis, Steve, Sebire, Guillaume, Willan, Andrew, Kirton, Adam, Goldenberg, Neil, Saengpattrachai, Montri, Crosswell, Hal, Rivkin, Michael, Bjornson, Bruce, Tatishvili, Nana, Brankovic-Sreckovic, Vesna, Bernard, Timothy, Armstrong, Jennifer, Humphreys, Peter, Heyer, Geoffrey, Fryer, Robert, Yeh, Ann, Billinghurst, Lori, Khoury, Chaouki, Abraham, Lisa, Whelan, Harry, Nowak-Gottl, Ulrike, Wainwright, Mark, Condie, John, Carpenter, Jessica, Holzhauer, Susanne, Guang, Yang, Zou, Li Ping and Taylor, J. Michael , International Pediatric Stroke Study Investigators (2018) Mortality after pediatric arterial ischemic stroke. Pediatrics, 141 (5), [e20174146]. (doi:10.1542/peds.2017-4146).

Record type: Article

Abstract

OBJECTIVES: Cerebrovascular disease is among the top 10 causes of death in US children, but risk factors for mortality are poorly understood. Within an international registry, we identify predictors of in-hospital mortality after pediatric arterial ischemic stroke (AIS). METHODS: Neonates (0-28 days) and children (29 days-<19 years) with AIS were enrolled from January 2003 to July 2014 in a multinational stroke registry. Death during hospitalization and cause of death were ascertained from medical records. Logistic regression was used to analyze associations between risk factors and in-hospital mortality. RESULTS: Fourteen of 915 neonates (1.5%) and 70 of 2273 children (3.1%) died during hospitalization. Of 48 cases with reported causes of death, 31 (64.6%) were strokerelated, with remaining deaths attributed to medical disease. In multivariable analysis, congenital heart disease (odds ratio [OR]: 3.88; 95% confidence interval [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) were associated with in-hospital mortality for neonates. 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) were associated with in-hospital mortality for children. CONCLUSIONS: In-hospital mortality occurred in 2.6% of pediatric AIS cases. Most deaths were attributable to stroke. Risk factors for in-hospital mortality included congenital heart disease and posterior plus anterior circulation stroke. Presentation without seizures and Hispanic ethnicity were also associated with mortality for neonates and children, respectively. Awareness and study of risk factors for mortality represent opportunities to increase survival.

Text
Beslow mortality - Accepted Manuscript
Available under License University of Southampton Accepted Manuscript Licence.
Download (685kB)

More information

e-pub ahead of print date: 25 April 2018
Published date: 1 May 2018

Identifiers

Local EPrints ID: 424307
URI: http://eprints.soton.ac.uk/id/eprint/424307
DOI: doi:10.1542/peds.2017-4146
ISSN: 0031-4005
PURE UUID: 4d5343c7-1416-42f7-acec-4ac94af38fd7
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 05 Oct 2018 11:36
Last modified: 16 Mar 2024 07:03

Export record

Altmetrics

Contributors

Author: Lauren A. Beslow
Author: Michael M. Dowling
Author: Sahar M.A. Hassanein
Author: John K. Lynch
Author: Dimitrios Zafeiriou
Author: Lisa R. Sun
Author: Ilona Kopyta
Author: Luigi Titomanlio
Author: Anneli Kolk
Author: Anthony Chan
Author: Jose Biller
Author: Eric F. Grabowski
Author: Abdalla A. Abdalla
Author: Mark T. Mackay
Author: Gabrielle DeVeber
Author: Steve Ashwal
Author: Donna Ferriero
Author: Heather Fullerton
Author: Rebecca Ichord
Author: Fenella Kirkham ORCID iD
Author: Finbar O'Callaghan
Author: Steve Pavlakis
Author: Guillaume Sebire
Author: Andrew Willan
Author: Adam Kirton
Author: Neil Goldenberg
Author: Montri Saengpattrachai
Author: Hal Crosswell
Author: Michael Rivkin
Author: Bruce Bjornson
Author: Nana Tatishvili
Author: Vesna Brankovic-Sreckovic
Author: Timothy Bernard
Author: Jennifer Armstrong
Author: Peter Humphreys
Author: Geoffrey Heyer
Author: Robert Fryer
Author: Ann Yeh
Author: Lori Billinghurst
Author: Chaouki Khoury
Author: Lisa Abraham
Author: Harry Whelan
Author: Ulrike Nowak-Gottl
Author: Mark Wainwright
Author: John Condie
Author: Jessica Carpenter
Author: Susanne Holzhauer
Author: Yang Guang
Author: Li Ping Zou
Author: J. Michael Taylor
Corporate Author: International Pediatric Stroke Study Investigators

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Library staff additional information
Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×