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

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

Identifiers

Local EPrints ID: 424307
URI: https://eprints.soton.ac.uk/id/eprint/424307
ISSN: 0031-4005
PURE UUID: 4d5343c7-1416-42f7-acec-4ac94af38fd7

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Date deposited: 05 Oct 2018 11:36
Last modified: 22 May 2019 04:01

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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
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

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