Division of Neurology, Children's Hospital of Philadelphia, and Departments of Neurology and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
Departments of Pediatrics and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas.
Pediatrics. 2018 May;141(5). doi: 10.1542/peds.2017-4146.
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).
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.
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 stroke-related, 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; = .021), posterior plus anterior circulation stroke (OR: 5.36; 95% CI: 1.70-16.85; = .004), and stroke presentation without seizures (OR: 3.95; 95% CI: 1.26-12.37; = .019) were associated with in-hospital mortality for neonates. Hispanic ethnicity (OR: 3.12; 95% CI: 1.56-6.24; = .001), congenital heart disease (OR: 3.14; 95% CI: 1.75-5.61; < .001), and posterior plus anterior circulation stroke (OR: 2.71; 95% CI: 1.40-5.25; = .003) were associated with in-hospital mortality for children.
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.
脑血管疾病是美国儿童十大死因之一，但对其死亡风险因素仍知之甚少。在一个国际注册中心，我们确定了儿科动脉缺血性脑卒中（AIS）后住院死亡率的预测因素。
2003 年 1 月至 2014 年 7 月，来自多国的脑卒中登记处招募了患有 AIS 的新生儿（0-28 天）和儿童（29 天-<19 岁）。从病历中确定住院期间的死亡情况和死因。使用 logistic 回归分析风险因素与住院死亡率之间的关系。
915 例新生儿中有 14 例（1.5%）和 2273 例儿童中有 70 例（3.1%）在住院期间死亡。在报告死因的 48 例中，31 例（64.6%）与脑卒中相关，其余死亡归因于医疗疾病。多变量分析显示，先天性心脏病（比值比[OR]：3.88；95%置信区间[CI]：1.23-12.29； =.021）、前后循环同时受累（OR：5.36；95% CI：1.70-16.85； =.004）和无癫痫发作的脑卒中表现（OR：3.95；95% CI：1.26-12.37； =.019）与新生儿住院死亡率相关。西班牙裔（OR：3.12；95% CI：1.56-6.24； =.001）、先天性心脏病（OR：3.14；95% CI：1.75-5.61； <.001）和前后循环同时受累（OR：2.71；95% CI：1.40-5.25； =.003）与儿童住院死亡率相关。
儿科 AIS 病例中，住院死亡率为 2.6%。大多数死亡归因于脑卒中。住院死亡率的风险因素包括先天性心脏病和前后循环同时受累。无癫痫发作和西班牙裔也是新生儿和儿童死亡的相关因素。认识和研究死亡风险因素是提高生存率的机会。
