Mortality after pediatric arterial ischemic stroke

International Pediatric Stroke Study Investigators

doi:10.1542/peds.2017-4146

Mortality after pediatric arterial ischemic stroke

International Pediatric Stroke Study Investigators

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

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.

Original language	English (US)
Article number	e20174146
Journal	Pediatrics
Volume	141
Issue number	5
DOIs	https://doi.org/10.1542/peds.2017-4146
State	Published - May 2018

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1542/peds.2017-4146

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@article{995dd91037b64cd0ad515820504f751f,

title = "Mortality after pediatric arterial ischemic stroke",

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.",

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

note = "Funding Information: Contributing Members of the IPSS (2003–2014): Ain Shams University: Sahar Hassanein, MD, PhD; Akron Children{\textquoteright}s Hospital: Abdalla Abdalla, MD; Alberta Children's Hospital: Adam Kirton, MD; All Children{\textquoteright}s Hospital: Neil Goldenberg, MD; Aristotle University of Thessaloniki: Dimitirios Zafeiriou, MD, PhD; Bangkok Hospital: Montri Saengpattrachai, MD; BiLo Charities Children{\textquoteright}s Cancer Center: Hal Crosswell, MD; Boston Children{\textquoteright}s Hospital: Michael Rivkin, MD; British Columbia Children's Hospital: Bruce Bjornson,MD; Children{\textquoteright}s Central Hospital: Nana Tatishvili, MD; Clinic for Child Neurology & Psychiatry, University of Belgrade: Vesna Brankovic-Sreckovic, MD; Children{\textquoteright}s Clinic of Tartu University Hospital: Anneli Kolk, MD; Children{\textquoteright}s Hospital Colorado: Timothy Bernard, MD, Jennifer Armstrong, MD; Children{\textquoteright}s Hospital of Eastern Ontario: Peter Humphreys, MD; Children{\textquoteright}s Hospital of New York: Geoffrey Heyer, MD, Robert Fryer, MD; Children{\textquoteright}s Hospital of Buffalo: Ann Yeh, MD; Children{\textquoteright}s Hospital of Philadelphia: Rebecca Ichord, MD, Lori Billinghurst, MD; Children's Hospital of Oklahoma: Chaouki Khoury, MD; Children{\textquoteright}s Hospital of Pittsburgh: Lisa Abraham, MD; Children{\textquoteright}s Hospital of Wisconsin: Harry Whelan, MD; Children's Medical Centre Munster: Ulrike Nowak-Gottl, MD; Children{\textquoteright}s Memorial Hospital: Mark Wainwright, MD, PhD, John Condie, MD; Children{\textquoteright}s National Medical Center: Jessica Carpenter, MD; Charite University Hospital: Susanne Holzhauer, MD; Chinese PLA General Hospital: Yang Guang, MD, Li-Ping Zou MD; Cincinnati Children{\textquoteright}s Hospital Medical Center: J. Michael Taylor, MD; Cleveland Clinic Foundation: Neil Friedman, MD; Clinica Davila: Luis Conto, MD; Columbia University Medical Centre: Sally Sultan, MD, Mitchell Elkind, MD; Cook Children{\textquoteright}s Hospital: Marcela Torres, MD; Georgetown University Medical Center: Nassim Zecavati, MD; Great Ormond Street Hospital: Vijeya Ganesan, MD; Hospital Carlos Van Buren: Lucila Andrade Alveal, MD; Hospital Clinico San Borja Arriaran: Monica Troncoso, MD; Hospital Italiano: Diana Altuna, MD; Hospital Regional Universitario (Carlos Haya): Patricia Garcia Soler, MD; Hospital Sant Joan de Deu: Veronica Gonzalez, MD; The Hospital for Sick Children: Gabrielle deVeber, MD, Mahendranath Moharir, MD, Nomazulu Dlamini, MD, PhD; Indiana Hemophilia and Thrombosis Center: Frederico Xavier, MD; Janeway Children{\textquoteright}s Health and Rehabilitation: David Buckley, MD; Jaslok Hospital and Research Centre: Anaita Hegde, MD; John Hunter Children{\textquoteright}s Hospital: Christina Miteff, MD; Johns Hopkins Hospital: Ryan Felling, MD, PhD; Life Memorial Hospital Bucharest: Adrian Toma, MD; Loma Linda University School of Medicine: Stephen Ashwal, MD, Chalmer McClure, MD; Maimonides Medical Center: Steven Pavlakis, MD; Massachusetts General Hospital for Children: Eric Grabowski, MD; McMaster University Medical Centre: Anthony Chan, MD; Medical University of Silesia: Ilona Kopyta, MD, PhD; Medical University of Vienna: Francesco Cardona, MD; Miami Children{\textquoteright}s Hospital: Marcel Deray, MD; Monroe Carell Jr. Children's Hospital at Vanderbilt: Lori Jordan, MD, PhD, Juliann Paolicchi, MD; Mother and Child Health Care Institute: Gordana Kovacevic, MD; Nationwide Children{\textquoteright}s Hospital: Warren Lo, MD, Melissa Chung, MD, JoEllen Lee, CNP; New York Presbyterian Hospital/ Weill Cornell Medical Center: Barry Kosofsky, MD, Dana Leifer, MD; New York University, School of Medicine: Ruth Nass, MD; Ohio Stroke Registry: Max Wiznitzer, MD; Oregon Health and Science University: Jenny Wilson, MD, Jason Coryell, MD, Carter Wray MD; Phoenix Children's Hospital: John Condie, MD; Paediatrics Institute Hospital Kuala Lumpur: Terrence Gerard, MD; Pontificia Universidad Catolica de Chile: Marta Hernandez, Funding Information: IPSS Group Original Investigators: Loma Linda University School of Medicine, Loma Linda, California: Steve Ashwal, MD; Hospital for Sick Children, Toronto, Ontario, Canada: Gabrielle deVeber, MD, MHSc; University of California, San Francisco, California: Donna Ferriero, MD, Heather Fullerton, MD; Children{\textquoteright}s Hospital of Philadelphia, Philadelphia, Pennsylvania: Rebecca Ichord, MD; Institute of Child Health, University College London, London, United Kingdom: Fenella Kirkham, MB, BChir; National Institutes of Health/National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland: John K. Lynch, DO, MPH; Bristol Royal Hospital for Children, Bristol, United Kingdom: Finbar O{\textquoteright}Callaghan, MBChB; Maimonides Medical Center, Brooklyn, New York: Steve Pavlakis, MD; Universit{\'e} de Sherbrooke Fleurimont, Sherbrooke, Qu{\'e}bec, Canada: Guillaume Sebire, MD, PhD; and Hospital for Sick Children, Toronto, Ontario, Canada: Andrew Willan, MSc, PhD. Funding Information: aDivision of Neurology, Children{\textquoteright}s Hospital of Philadelphia, and Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; bDepartments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas; cDepartment of Pediatrics, Ain Shams University, Cairo, Egypt; dSection on Stroke Diagnostics and Therapeutics, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; eDivision of Child Neurology and Developmental Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece; fDepartment of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland; gDepartment of Pediatric Neurology, School of Medicine, Medical University of Silesia, Katowice, Poland; hPediatric Emergency D{\'e}partement, H{\^o}pital Robert Debr{\'e}, Paris, France; iDepartment of Neuropsychology, University of Tartu, Tartu, Estonia; jDepartment of Pediatrics, McMaster Children{\textquoteright}s Hospital, McMaster University, Hamilton, Canada; kDepartment of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; lDepartment of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; mDepartment of Neurosciences, Al Jalila Children{\textquoteright}s Hospital, Dubai, United Arab Emirates; nDepartment of Neurology, The Royal Children{\textquoteright}s Hospital, Melbourne, Australia; and oDivision of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada Publisher Copyright: {\textcopyright} Copyright 2018 by the American Academy of Pediatrics.",

year = "2018",

month = may,

doi = "10.1542/peds.2017-4146",

language = "English (US)",

volume = "141",

journal = "Pediatrics",

issn = "0031-4005",

publisher = "American Academy of Pediatrics",

number = "5",

}

TY - JOUR

T1 - Mortality after pediatric arterial ischemic stroke

AU - International Pediatric Stroke Study Investigators

AU - Beslow, Lauren A.

AU - Dowling, Michael M.

AU - Hassanein, Sahar M.A.

AU - Lynch, John K.

AU - Zafeiriou, Dimitrios

AU - Sun, Lisa R.

AU - Kopyta, Ilona

AU - Titomanlio, Luigi

AU - Kolk, Anneli

AU - Chan, Anthony

AU - Biller, Jose

AU - Grabowski, Eric F.

AU - Abdalla, Abdalla A.

AU - Mackay, Mark T.

AU - DeVeber, Gabrielle

AU - Ashwal, Steve

AU - Ferriero, Donna

AU - Fullerton, Heather

AU - Ichord, Rebecca

AU - Kirkham, Fenella

AU - O'Callaghan, Finbar

AU - Pavlakis, Steve

AU - Sebire, Guillaume

AU - Willan, Andrew

AU - Kirton, Adam

AU - Goldenberg, Neil

AU - Saengpattrachai, Montri

AU - Crosswell, Hal

AU - Rivkin, Michael

AU - Bjornson, Bruce

AU - Tatishvili, Nana

AU - Brankovic-Sreckovic, Vesna

AU - Bernard, Timothy

AU - Armstrong, Jennifer

AU - Humphreys, Peter

AU - Heyer, Geoffrey

AU - Fryer, Robert

AU - Yeh, Ann

AU - Billinghurst, Lori

AU - Khoury, Chaouki

AU - Abraham, Lisa

AU - Whelan, Harry

AU - Nowak-Gottl, Ulrike

AU - Wainwright, Mark

AU - Condie, John

AU - Carpenter, Jessica

AU - Holzhauer, Susanne

AU - Guang, Yang

AU - Zou, Li Ping

AU - Journeycake, Janna

N1 - Funding Information: Contributing Members of the IPSS (2003–2014): Ain Shams University: Sahar Hassanein, MD, PhD; Akron Children’s Hospital: Abdalla Abdalla, MD; Alberta Children's Hospital: Adam Kirton, MD; All Children’s Hospital: Neil Goldenberg, MD; Aristotle University of Thessaloniki: Dimitirios Zafeiriou, MD, PhD; Bangkok Hospital: Montri Saengpattrachai, MD; BiLo Charities Children’s Cancer Center: Hal Crosswell, MD; Boston Children’s Hospital: Michael Rivkin, MD; British Columbia Children's Hospital: Bruce Bjornson,MD; Children’s Central Hospital: Nana Tatishvili, MD; Clinic for Child Neurology & Psychiatry, University of Belgrade: Vesna Brankovic-Sreckovic, MD; Children’s Clinic of Tartu University Hospital: Anneli Kolk, MD; Children’s Hospital Colorado: Timothy Bernard, MD, Jennifer Armstrong, MD; Children’s Hospital of Eastern Ontario: Peter Humphreys, MD; Children’s Hospital of New York: Geoffrey Heyer, MD, Robert Fryer, MD; Children’s Hospital of Buffalo: Ann Yeh, MD; Children’s Hospital of Philadelphia: Rebecca Ichord, MD, Lori Billinghurst, MD; Children's Hospital of Oklahoma: Chaouki Khoury, MD; Children’s Hospital of Pittsburgh: Lisa Abraham, MD; Children’s Hospital of Wisconsin: Harry Whelan, MD; Children's Medical Centre Munster: Ulrike Nowak-Gottl, MD; Children’s Memorial Hospital: Mark Wainwright, MD, PhD, John Condie, MD; Children’s National Medical Center: Jessica Carpenter, MD; Charite University Hospital: Susanne Holzhauer, MD; Chinese PLA General Hospital: Yang Guang, MD, Li-Ping Zou MD; Cincinnati Children’s Hospital Medical Center: J. Michael Taylor, MD; Cleveland Clinic Foundation: Neil Friedman, MD; Clinica Davila: Luis Conto, MD; Columbia University Medical Centre: Sally Sultan, MD, Mitchell Elkind, MD; Cook Children’s Hospital: Marcela Torres, MD; Georgetown University Medical Center: Nassim Zecavati, MD; Great Ormond Street Hospital: Vijeya Ganesan, MD; Hospital Carlos Van Buren: Lucila Andrade Alveal, MD; Hospital Clinico San Borja Arriaran: Monica Troncoso, MD; Hospital Italiano: Diana Altuna, MD; Hospital Regional Universitario (Carlos Haya): Patricia Garcia Soler, MD; Hospital Sant Joan de Deu: Veronica Gonzalez, MD; The Hospital for Sick Children: Gabrielle deVeber, MD, Mahendranath Moharir, MD, Nomazulu Dlamini, MD, PhD; Indiana Hemophilia and Thrombosis Center: Frederico Xavier, MD; Janeway Children’s Health and Rehabilitation: David Buckley, MD; Jaslok Hospital and Research Centre: Anaita Hegde, MD; John Hunter Children’s Hospital: Christina Miteff, MD; Johns Hopkins Hospital: Ryan Felling, MD, PhD; Life Memorial Hospital Bucharest: Adrian Toma, MD; Loma Linda University School of Medicine: Stephen Ashwal, MD, Chalmer McClure, MD; Maimonides Medical Center: Steven Pavlakis, MD; Massachusetts General Hospital for Children: Eric Grabowski, MD; McMaster University Medical Centre: Anthony Chan, MD; Medical University of Silesia: Ilona Kopyta, MD, PhD; Medical University of Vienna: Francesco Cardona, MD; Miami Children’s Hospital: Marcel Deray, MD; Monroe Carell Jr. Children's Hospital at Vanderbilt: Lori Jordan, MD, PhD, Juliann Paolicchi, MD; Mother and Child Health Care Institute: Gordana Kovacevic, MD; Nationwide Children’s Hospital: Warren Lo, MD, Melissa Chung, MD, JoEllen Lee, CNP; New York Presbyterian Hospital/ Weill Cornell Medical Center: Barry Kosofsky, MD, Dana Leifer, MD; New York University, School of Medicine: Ruth Nass, MD; Ohio Stroke Registry: Max Wiznitzer, MD; Oregon Health and Science University: Jenny Wilson, MD, Jason Coryell, MD, Carter Wray MD; Phoenix Children's Hospital: John Condie, MD; Paediatrics Institute Hospital Kuala Lumpur: Terrence Gerard, MD; Pontificia Universidad Catolica de Chile: Marta Hernandez, Funding Information: IPSS Group Original Investigators: Loma Linda University School of Medicine, Loma Linda, California: Steve Ashwal, MD; Hospital for Sick Children, Toronto, Ontario, Canada: Gabrielle deVeber, MD, MHSc; University of California, San Francisco, California: Donna Ferriero, MD, Heather Fullerton, MD; Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania: Rebecca Ichord, MD; Institute of Child Health, University College London, London, United Kingdom: Fenella Kirkham, MB, BChir; National Institutes of Health/National Institute of Neurologic Disorders and Stroke, Bethesda, Maryland: John K. Lynch, DO, MPH; Bristol Royal Hospital for Children, Bristol, United Kingdom: Finbar O’Callaghan, MBChB; Maimonides Medical Center, Brooklyn, New York: Steve Pavlakis, MD; Université de Sherbrooke Fleurimont, Sherbrooke, Québec, Canada: Guillaume Sebire, MD, PhD; and Hospital for Sick Children, Toronto, Ontario, Canada: Andrew Willan, MSc, PhD. Funding Information: aDivision of Neurology, Children’s Hospital of Philadelphia, and Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; bDepartments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas; cDepartment of Pediatrics, Ain Shams University, Cairo, Egypt; dSection on Stroke Diagnostics and Therapeutics, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; eDivision of Child Neurology and Developmental Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece; fDepartment of Neurology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland; gDepartment of Pediatric Neurology, School of Medicine, Medical University of Silesia, Katowice, Poland; hPediatric Emergency Département, Hôpital Robert Debré, Paris, France; iDepartment of Neuropsychology, University of Tartu, Tartu, Estonia; jDepartment of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Canada; kDepartment of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; lDepartment of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts; mDepartment of Neurosciences, Al Jalila Children’s Hospital, Dubai, United Arab Emirates; nDepartment of Neurology, The Royal Children’s Hospital, Melbourne, Australia; and oDivision of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada Publisher Copyright: © Copyright 2018 by the American Academy of Pediatrics.

PY - 2018/5

Y1 - 2018/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85046426400&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046426400&partnerID=8YFLogxK

U2 - 10.1542/peds.2017-4146

DO - 10.1542/peds.2017-4146

M3 - Article

C2 - 29695585

AN - SCOPUS:85046426400

SN - 0031-4005

VL - 141

JO - Pediatrics

JF - Pediatrics

IS - 5

M1 - e20174146

ER -

Mortality after pediatric arterial ischemic stroke

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