School of Medicine, New York Medical College, Valhalla, NY, USA.
Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
Int J Stroke. 2023 Jun;18(5):555-561. doi: 10.1177/17474930221130911. Epub 2022 Nov 15.
Although intravenous thrombolysis (IVT) represents standard-of-care treatment for acute ischemic stroke (AIS) in eligible adult patients, definitive evidence-based guidelines and randomized clinical trial data evaluating its safety and efficacy in the pediatric population remain absent from the literature. We aimed to evaluate the utilization and outcomes of IVT for the treatment of pediatric AIS using a large national registry.
Weighted hospitalizations for pediatric (<18 years of age) AIS patients were identified in the National Inpatient Sample during the period of 2001 to 2019. Complex sample statistical methods were performed to assess unadjusted and adjusted outcomes in patients treated with IVT or other medical management.
Among 13,901 pediatric AIS patients, 270 (1.9%) were treated with IVT monotherapy (median age 12.8 years). IVT-treated patients developed any intracranial hemorrhage (ICH) at a rate of 5.6% (n = 15), and 71.9% (n = 194) experienced favorable functional outcomes at discharge (to home or to acute rehabilitation). Following propensity-score adjustment for age, acute stroke severity, infarct location, and etiological/comorbid conditions, IVT was not associated with an increased risk of any ICH (5.6% vs 5.4%, p = 0.931; adjusted odds ratio (aOR) = 1.01, 95% confidence interval (CI) = 0.48-2.14, p = 0.971), nor with favorable functional outcome (71.9% vs 74.5%, p = 0.489; aOR = 0.88, 95% CI = 0.60-1.29, p = 0.511) in comparison with other medical therapy.
Twenty years of population-level data in the United States demonstrate that pediatric AIS patients treated with IVT experienced high rates of favorable outcomes without an increased risk of hemorrhagic transformation.
尽管静脉溶栓（IVT）是符合条件的成年急性缺血性脑卒中（AIS）患者的标准治疗方法，但在儿科人群中，仍缺乏关于其安全性和有效性的明确循证指南和随机临床试验数据。我们旨在利用大型国家登记处评估 IVT 治疗儿科 AIS 的应用情况和结局。
在 2001 年至 2019 年期间，我们在国家住院患者样本（National Inpatient Sample）中确定了儿科（<18 岁）AIS 患者的加权住院人数。采用复杂样本统计方法评估接受 IVT 或其他药物治疗的患者的未调整和调整结局。
在 13901 例儿科 AIS 患者中，有 270 例（1.9%）接受了 IVT 单药治疗（中位年龄为 12.8 岁）。IVT 治疗组颅内出血（ICH）发生率为 5.6%（n=15），出院时 71.9%（n=194）功能结局良好（返家或转至急性康复科）。经年龄、急性脑卒中严重程度、梗死部位和病因/合并症进行倾向评分调整后，IVT 与 ICH 风险增加无关（5.6% vs 5.4%，p=0.931；调整后的优势比[aOR]为 1.01，95%置信区间[CI]为 0.48-2.14，p=0.971），与其他药物治疗相比，也与良好的功能结局无关（71.9% vs 74.5%，p=0.489；aOR 为 0.88，95%CI 为 0.60-1.29，p=0.511）。
美国 20 年的人群数据表明，接受 IVT 治疗的儿科 AIS 患者结局良好率较高，且未增加出血转化风险。
