Cardiovascular Institute, the Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Neurology. 2012 Jun 12;78(24):1923-9. doi: 10.1212/WNL.0b013e318259e25c. Epub 2012 May 30.
To examine the trends in incidence and long-term case fatality of childhood stroke in New Jersey using a statewide administrative database for the years 1994-2007.
We assessed demographic and clinical information for children with stroke using the Myocardial Infarction Data Acquisition System (MIDAS) database. We ascertained deaths by matching MIDAS records to New Jersey Death Registration Files at 30 days, 1 year, and 5 years from the index stroke.
During the 14-year study period, 715 children were hospitalized for a first time with stroke. Age-adjusted incidence of stroke demonstrated a significant quadratic trend in which the rates decreased from 1994 to a nadir at 1999-2001 and increased thereafter (overall p for trend = 0.06 with quadratic term p = 0.02). Better treatment of sickle cell disease with transfusion therapy after year 1998 (p = 0.007) and improved diagnostic accuracy of MRI (p = 0.009) may partially explain these trends. Thirty-day, 1-year, and 5-year case fatality rates were 12.3%, 15.7%, and 17.5%, respectively. At all time periods, adjusted survival from hemorrhagic stroke was significantly lower than that from ischemic stroke (p = 0.0005).
After an initial decrease, the incidence of pediatric stroke is rising. Children with hemorrhagic stroke had a 2 times higher risk of death than those with ischemic stroke. Whereas approximately 70% of all deaths occurred within the first month of hospitalization, an additional 5.2% of the initial study cohort died over the next 5 years.
利用新泽西州的全州行政数据库，研究 1994 年至 2007 年期间儿童脑卒中发病率和长期病死率的趋势。
我们使用心肌梗死数据采集系统（MIDAS）数据库评估了患有脑卒中的儿童的人口统计学和临床信息。通过将 MIDAS 记录与新泽西州死亡登记文件相匹配，我们确定了 30 天、1 年和 5 年的死亡人数。
在 14 年的研究期间，有 715 名儿童首次因脑卒中住院。经年龄调整后，脑卒中的发病率呈显著二次曲线趋势，其发病率从 1994 年下降到 1999-2001 年的最低点，此后又有所上升（整体趋势 p 值为 0.06，二次项 p 值为 0.02）。1998 年后输血治疗镰状细胞病的疗效改善（p = 0.007）和 MRI 诊断准确性提高（p = 0.009）可能部分解释了这些趋势。30 天、1 年和 5 年的病死率分别为 12.3%、15.7%和 17.5%。在所有时间段，出血性脑卒中的调整后生存率均显著低于缺血性脑卒中（p = 0.0005）。
在最初下降后，儿科脑卒中的发病率正在上升。出血性脑卒中患儿的死亡风险比缺血性脑卒中患儿高 2 倍。尽管约 70%的死亡发生在住院后的第一个月内，但在接下来的 5 年内，初始研究队列中又有 5.2%的患者死亡。
