Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Crown Princess Victoria's Children's and Youth Hospital, University Hospital, Linköping, Sweden.
Paediatr Perinat Epidemiol. 2022 May;36(3):412-421. doi: 10.1111/ppe.12869. Epub 2022 Feb 16.
Various frequencies of adverse motor outcomes (cerebral palsy and hemiplegia) after paediatric ischaemic stroke have been reported. Few reports on the risks of adverse motor outcomes in nationwide cohorts and contributing risk factors are available.
To assess risk of adverse motor outcome and potential risk factors thereof after paediatric ischaemic stroke in a nationwide cohort.
This nationwide matched cohort study identified 877 children <18 years of age diagnosed with ischaemic stroke through the Swedish national health registers from 1997 to 2016. These children, exposed to ischaemic stroke, alive 1 week after stroke, were matched for age, sex and county of residence with 10 unexposed children. Using Cox regression, we estimated the risk of adverse motor outcomes in children with stroke compared to that in unexposed children. Logistic regression was applied to compare the characteristics of children with and without adverse motor outcomes after stroke.
Out of the 877 children with ischaemic stroke, 280 (31.9%) suffered adverse motor outcomes compared with 21 (0.2%) of the 8770 unexposed: adjusted hazard ratio (aHR) 167.78 (95% confidence interval (CI) 107.58, 261.66). There were no differences between risk estimates of adverse motor outcome according to age at stroke: perinatal stroke (aHR 124.11, 95% CI 30.45, 505.84) and childhood stroke (aHR 182.37, 95% CI 113.65, 292.64). An association between adverse motor outcome and childhood stroke aOR 1.56 (95% CI 1.05, 2.31) was found when analysing only children with ischaemic stroke. No associations were found between adverse motor outcome and sex, gestational age or parental age at birth.
The risk of adverse motor outcome is substantial after paediatric ischaemic stroke, especially childhood stroke, confirming results of previous smaller studies. This study found no associations between sex, gestational age or parental age and adverse motor outcome after paediatric ischaemic stroke.
儿科缺血性中风后，各种频率的不良运动结局（脑瘫和偏瘫）已有报道。关于全国性队列中不良运动结局的风险以及潜在的危险因素的报告很少。
在全国性队列中评估儿科缺血性中风后不良运动结局的风险及其潜在危险因素。
这项全国性匹配队列研究通过瑞典国家健康登记册，从 1997 年至 2016 年共识别出 877 名年龄<18 岁的缺血性中风患儿。这些患儿在中风后 1 周内存活且存在缺血性中风，按照年龄、性别和居住地与 10 名未暴露于中风的患儿进行匹配。使用 Cox 回归估计与未暴露于中风的患儿相比，患有中风的患儿不良运动结局的风险。应用 logistic 回归比较中风后有和无不良运动结局患儿的特征。
877 名缺血性中风患儿中，280 名（31.9%）发生不良运动结局，而 8770 名未暴露于中风的患儿中仅 21 名（0.2%）发生不良运动结局：调整后的危险比（aHR）为 167.78（95%置信区间（CI）为 107.58，261.66）。根据中风时的年龄，不良运动结局的风险估计值没有差异：围产期中风（aHR 124.11，95%CI 30.45，505.84）和儿童期中风（aHR 182.37，95%CI 113.65，292.64）。仅分析缺血性中风患儿时，发现不良运动结局与儿童期中风之间存在关联，优势比（aOR）为 1.56（95%CI 1.05，2.31）。性别、胎龄或父母出生年龄与不良运动结局之间无关联。
儿科缺血性中风后不良运动结局的风险很大，尤其是儿童期中风，这证实了之前较小研究的结果。本研究未发现性别、胎龄或父母出生年龄与儿科缺血性中风后不良运动结局之间存在关联。
