Department of Neurology, University of California at San Francisco, CA 94143, USA.
Ann Neurol. 2012 Dec;72(6):850-8. doi: 10.1002/ana.23688.
Trauma and acute infection have been associated with stroke in adults, and are prevalent exposures in children. We hypothesized that these environmental factors are independently associated with childhood arterial ischemic stroke (AIS).
In a case-control study nested within a cohort of 2.5 million children (≤19 years old) enrolled in an integrated health care plan (1993-2007), childhood AIS cases (n = 126) were identified from electronic records and confirmed through chart review. Age- and facility-matched controls (n = 378) were randomly selected from the cohort. Exposures were determined from review of medical records prior to the stroke diagnosis, or the same date for the paired controls; time windows were defined a priori.
A medical encounter for head or neck trauma within the prior 12 weeks was an independent risk factor for childhood AIS (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.9-19.3), present in 12% of cases (1.6% of controls). Median time from trauma to stroke was 0.5 days (interquartile range, 0-2 days); post hoc redefinition of trauma exposure (prior 1 week) was more strongly associated with AIS: OR, 39; 95% CI, 5.1-298. A medical encounter for a minor acute infection (prior 4 weeks) was also an independent risk factor (OR, 4.6; 95% CI, 2.6-8.2), present in 33% of cases (13% of controls). No single infection type predominated. Only 2 cases had exposure to trauma and infection.
Trauma and acute infection are common independent risk factors for childhood AIS, and may be targets for stroke prevention strategies.
创伤和急性感染与成年人的中风有关，并且在儿童中普遍存在。我们假设这些环境因素与儿童动脉缺血性中风（AIS）独立相关。
在一项嵌套于 250 万儿童队列中的病例对照研究中（1993-2007 年），通过电子病历识别儿童 AIS 病例（n=126），并通过病历回顾进行确认。年龄和设施匹配的对照（n=378）从队列中随机选择。暴露情况通过回顾中风诊断前或配对对照的同一日期的病历确定；时间窗口事先定义。
在过去 12 周内，头部或颈部创伤的医疗接触是儿童 AIS 的独立危险因素（比值比[OR]，7.5；95%置信区间[CI]，2.9-19.3），12%的病例（1.6%的对照）存在该危险因素。创伤到中风的中位时间为 0.5 天（四分位距，0-2 天）；事后重新定义创伤暴露（前 1 周）与 AIS 更密切相关：OR，39；95%CI，5.1-298。过去 4 周内的轻微急性感染的医疗接触也是一个独立的危险因素（OR，4.6；95%CI，2.6-8.2），33%的病例（13%的对照）存在这种感染。没有单一的感染类型占主导地位。只有 2 例暴露于创伤和感染。
创伤和急性感染是儿童 AIS 的常见独立危险因素，可能是中风预防策略的目标。
