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Arteriopathy influences pediatric ischemic stroke presentation, but sickle cell disease influences stroke management

Arteriopathy influences pediatric ischemic stroke presentation, but sickle cell disease influences stroke management
Arteriopathy influences pediatric ischemic stroke presentation, but sickle cell disease influences stroke management
Purpose: Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contribution of SCD and arteriopathy to stroke risk is unknown, resulting in unclear guidance for management when both risk factors are present. We hypothesized that despite similarities in presentation and arteriopathy, stroke management differs in children with SCD.
Methods: We compared presentation and management of children with SCD enrolled in the International Pediatric Stroke Study to non-SCD, non-cardiac children, according to SCD and arteriopathy (A) status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant differences in frequency.
Results: Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (OR 1.94 95% confidence intervals [CI] 1.46, 2.56) and speech abnormalities (OR 1.67; CI 1.29, 2.19). Arteriopathy also increased likelihood of headache, but only among those without SCD (OR 1.89 CI 1.40, 2.55). Echocardiograms were less frequently obtained in children with SCD (OR 0.58; CI 0.37, 0.93), but the frequency of abnormalities among those with echocardiography results were similar in both groups (p=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR 0.14; CI 0.08, 0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR 5.36; CI 3.55, 8.09).
Conclusion: Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management, as children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.
0039-2499
Guilliams, Kristin
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Kirkham, Fenella
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Holzhauer, Susanne
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Pavlakis, Steven
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Philbrook, Bryan
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Amlie-Lefond, Catherine
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Noetzel, Michael
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Dlamini, Nomazulu
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Sharma, Mukta
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Carpenter, Jessica L.
b3aba2ee-958e-4d06-bf90-823fd292fbf1
Fox, Christine
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Torres, Marcela
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Ichord, Rebecca
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Jordan, Lori C.
cbdcf9d9-160a-454e-95a0-ad750f7c450c
Dowling, Michael M.
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Guilliams, Kristin
4156590a-b50b-4688-aa03-3b4ce46f5431
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Holzhauer, Susanne
40cb664b-c63d-4947-9e49-eac6323ff54f
Pavlakis, Steven
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Philbrook, Bryan
021b2aa5-65c4-4f39-9e1b-be9fc546900a
Amlie-Lefond, Catherine
2a747f4e-d365-4254-9010-fb6bb1851957
Noetzel, Michael
033f094c-8388-4379-bb25-f56761d51c1d
Dlamini, Nomazulu
8def84c8-f529-4feb-ba06-a8723038a5c5
Sharma, Mukta
6a8e2f25-5ad4-4b67-8727-404bcc915806
Carpenter, Jessica L.
b3aba2ee-958e-4d06-bf90-823fd292fbf1
Fox, Christine
87eb2f88-bcd5-403a-9846-876382811518
Torres, Marcela
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Ichord, Rebecca
76738e44-196a-4b82-9357-53fa5feb325e
Jordan, Lori C.
cbdcf9d9-160a-454e-95a0-ad750f7c450c
Dowling, Michael M.
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Guilliams, Kristin, Kirkham, Fenella, Holzhauer, Susanne, Pavlakis, Steven, Philbrook, Bryan, Amlie-Lefond, Catherine, Noetzel, Michael, Dlamini, Nomazulu, Sharma, Mukta, Carpenter, Jessica L., Fox, Christine, Torres, Marcela, Ichord, Rebecca, Jordan, Lori C. and Dowling, Michael M. (2019) Arteriopathy influences pediatric ischemic stroke presentation, but sickle cell disease influences stroke management. Stroke. (doi:10.1161/STROKEAHA.118.022800).

Record type: Article

Abstract

Purpose: Sickle cell disease (SCD) and arteriopathy are pediatric stroke risk factors that are not mutually exclusive. The relative contribution of SCD and arteriopathy to stroke risk is unknown, resulting in unclear guidance for management when both risk factors are present. We hypothesized that despite similarities in presentation and arteriopathy, stroke management differs in children with SCD.
Methods: We compared presentation and management of children with SCD enrolled in the International Pediatric Stroke Study to non-SCD, non-cardiac children, according to SCD and arteriopathy (A) status. Regression modeling determined relative contribution of SCD and arteriopathy in variables with significant differences in frequency.
Results: Among 930 childhood arterial ischemic strokes, there were 98 children with SCD, 67 of whom had arteriopathy, and 466 without SCD, 392 of whom had arteriopathy. Arteriopathy, regardless of SCD status, increased likelihood of hemiparesis (OR 1.94 95% confidence intervals [CI] 1.46, 2.56) and speech abnormalities (OR 1.67; CI 1.29, 2.19). Arteriopathy also increased likelihood of headache, but only among those without SCD (OR 1.89 CI 1.40, 2.55). Echocardiograms were less frequently obtained in children with SCD (OR 0.58; CI 0.37, 0.93), but the frequency of abnormalities among those with echocardiography results were similar in both groups (p=0.57). Children with SCD were less likely to receive antithrombotic therapy, even in the presence of arteriopathy (OR 0.14; CI 0.08, 0.22). Arteriopathy was associated with a significantly higher likelihood of antithrombotic therapy in children without SCD (OR 5.36; CI 3.55, 8.09).
Conclusion: Arteriopathy, and not SCD status, was most influential of stroke presentation. However, SCD status influenced stroke management, as children with SCD were less likely to have echocardiograms or receive antithrombotic therapy. Further work is needed to determine whether management differences are warranted.

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IPSS SCD arteriopathy 2018_final - Accepted Manuscript
Restricted to Repository staff only until 15 October 2019.
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Accepted/In Press date: 11 March 2019
e-pub ahead of print date: 15 April 2019

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Local EPrints ID: 430182
URI: https://eprints.soton.ac.uk/id/eprint/430182
ISSN: 0039-2499
PURE UUID: bf9a6778-f790-4f9f-bfa3-6b83444b14ee
ORCID for Fenella Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 16 Apr 2019 16:30
Last modified: 21 Jun 2019 00:36

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Contributors

Author: Kristin Guilliams
Author: Fenella Kirkham ORCID iD
Author: Susanne Holzhauer
Author: Steven Pavlakis
Author: Bryan Philbrook
Author: Catherine Amlie-Lefond
Author: Michael Noetzel
Author: Nomazulu Dlamini
Author: Mukta Sharma
Author: Jessica L. Carpenter
Author: Christine Fox
Author: Marcela Torres
Author: Rebecca Ichord
Author: Lori C. Jordan
Author: Michael M. Dowling

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