Department of Neurology, University of California, San Francisco, CA, USA.
Neurology. 2012 Jul 31;79(5):420-7. doi: 10.1212/WNL.0b013e3182616fd7. Epub 2012 Jun 27.
To measure intensive care unit (ICU) admission, intubation, decompressive craniotomy, and outcomes at discharge in a large population-based study of children with ischemic and hemorrhagic stroke.
In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993-2003), we identified cases of symptomatic childhood stroke (age >28 days through 19 years) from inpatient and outpatient electronic diagnoses and radiology reports, and confirmed them through chart review. Data regarding stroke evaluation, management, and outcomes at discharge were abstracted. Intensive care unit (ICU) admission, intubation, and decompressive neurosurgery rates were measured, and multivariate logistic regression was used to identify predictors of critical care usage and outcomes at discharge.
Of 256 cases (132 hemorrhagic and 124 ischemic), 61% were admitted to the ICU, 32% were intubated, and 11% were treated with a decompressive neurosurgery. Rates were particularly high among children with hemorrhagic stroke (73% admitted to the ICU, 42% intubated, and 19% received a decompressive neurosurgery). Altered mental status at presentation was the most robust predictor for all 3 measures of critical care utilization. Neurologic deficits at discharge were documented in 57%, and were less common after hemorrhagic than ischemic stroke: 48% vs 66% (odds ratio 0.5, 95% confidence interval 0.3-0.8). Case fatality was 4% overall, 7% among children admitted to the ICU, and was similar between ischemic and hemorrhagic stroke.
ICU admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression.
在一项针对缺血性和出血性脑卒中儿童的大型基于人群的研究中，测量重症监护病房（ICU）入院、插管、减压性开颅术和出院结局。
在对加利福尼亚北部一个综合医疗保健计划中所有入组儿童（1993-2003 年）的回顾性研究中，我们从住院和门诊电子诊断和放射学报告中确定了有症状的儿童脑卒中（年龄>28 天至 19 岁）病例，并通过病历审查予以证实。提取了有关脑卒中评估、管理和出院结局的数据。测量了 ICU 入院、插管和减压神经外科的比例，并使用多变量逻辑回归来确定重症监护使用和出院结局的预测因素。
在 256 例病例中（132 例出血性和 124 例缺血性），61%的患儿被收入 ICU，32%的患儿插管，11%的患儿接受了减压神经外科治疗。出血性脑卒中患儿的这些比例特别高（73%收入 ICU，42%插管，19%接受减压神经外科治疗）。发病时意识改变是所有 3 项重症监护使用指标的最强预测因素。出院时存在神经功能缺损的病例有 57%，出血性脑卒中比缺血性脑卒中的比例要低：48%比 66%（比值比 0.5，95%置信区间 0.3-0.8）。总体病死率为 4%，入住 ICU 的患儿为 7%，在缺血性和出血性脑卒中之间相似。
儿童脑卒中后 ICU 入院率较高，且似乎有较高的插管和手术减压率作为依据。
