Factors Influencing Long-Term Outcomes in Childhood Arterial Ischemic Stroke

IF 2.1 3区医学 Q2 CLINICAL NEUROLOGY

Pediatric neurology Pub Date : 2025-05-15 DOI:10.1016/j.pediatrneurol.2025.05.015

Nicola D. Fearn MBChB , Maggie L. Yau MBChB , Jay Gajera MBBS , Paul Monagle MBBS, MD , Anneke Grobler PhD , Belinda Stojanovski RN , Vicki Anderson PhD , Anne Gordon PhD , Mardee Greenham PhD , Anna Cooper PhD , Mark T. Mackay MBBS, PhD

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Abstract

Background

Childhood arterial ischemic stroke (AIS) is associated with substantial long-term morbidity. This study aims to describe factors associated with recurrence, mortality, and neurological disability.

Methods

Australian children with radiologically confirmed AIS were enrolled prospectively to the Royal Children's Hospital stroke registry from 2003 to 2017. Data collected included demographics, clinical and radiological variables, Pediatric National Institutes of Health Stroke Scale severity score, and the Childhood AIS Standardized Classification and Diagnostic Evaluation etiology. Neurological outcomes were categorized as good (normal) or poor (mild/moderate/severe) using the Pediatric Stroke Outcome Measure Severity Classification Scheme.

Results

A total of 172 children with AIS were identified; 11% died (2% stroke-related), 15% had recurrent strokes (5% transient ischemic attacks), and 8% developed epilepsy. Pediatric Stroke Outcome Measure follow-up data were available for 131 children at a median 8.9 years of follow-up (interquartile range, 6.0-11.9). Risk factors for recurrence were arteriopathy (hazard ratio [HR], 2.75; confidence interval [CI], 1.47-5.15, P = 0.002) and hemiparesis (HR, 1.34; CI, 1.07-1.69, P = 0.012); 43% of children had poor long-term outcomes, which were associated with altered conscious state (odds ratio [OR], 2.79; CI, 1.25-6.22, P = 0.012) and neurosurgical intervention (OR, 3.20; CI, 1.55-6.59, P = 0.002).

Conclusions

Long-term neurological deficits are common in children with AIS in the prereperfusion therapy era. The use of pediatric-specific stroke assessment measures and etiologic classification systems enables this study to be a comparator for future stroke studies, measuring the impact of reperfusion therapies on outcomes in childhood AIS.

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影响儿童动脉缺血性卒中长期预后的因素

背景：儿童动脉缺血性卒中（AIS）与大量的长期发病率相关。本研究旨在描述与复发、死亡率和神经功能障碍相关的因素。方法2003年至2017年，澳大利亚皇家儿童医院卒中登记处前瞻性纳入放射学证实的AIS儿童。收集的数据包括人口统计学、临床和放射学变量、儿童国立卫生研究院卒中量表严重程度评分和儿童AIS标准化分类和诊断评估病因学。使用小儿卒中结局测量严重程度分类方案将神经系统预后分为良好（正常）或差（轻度/中度/严重）。结果共发现AIS患儿172例；11%死亡（2%与中风有关），15%复发性中风（5%短暂性脑缺血发作），8%发展为癫痫。儿童卒中结局测量随访数据为131名儿童，随访时间中位数为8.9年（四分位数范围为6.0-11.9）。复发的危险因素为动脉病变(危险比[HR]， 2.75；置信区间[CI]， 1.47 ~ 5.15, P = 0.002)和偏瘫(HR, 1.34；Ci, 1.07-1.69, p = 0.012)；43%的儿童长期预后较差，这与意识状态改变有关(优势比[OR]， 2.79；CI, 1.25-6.22, P = 0.012)和神经外科干预(OR, 3.20；Ci, 1.55-6.59, p = 0.002)。结论在预灌注治疗时代，AIS患儿长期神经功能缺损较为常见。使用儿科特异性卒中评估措施和病因分类系统使本研究成为未来卒中研究的比较物，测量再灌注治疗对儿童AIS预后的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric neurology 医学-临床神经学

CiteScore

4.80

自引率

2.60%

发文量

176

审稿时长

78 days

期刊介绍： Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.