Stroke in the pediatric intensive care unit

Objectives

To analyze the frequency, causes, risk factors, mortality and sequelae of stroke in children admitted to the pediatric intensive care unit (PICU).

Design

Single-center retrospective observational study based on a prospective database.

Setting

Pediatric intensive care unit.

Patients

Children between one month and eighteen years of age admitted to the PICU and diagnosed with stroke were included.

Main variables of interest

Epidemiological, clinical, diagnostic and treatment data, sequelae and mortality were recorded.

Interventions

None.

Results

46 patients were studied, of whom 29 (63%) had an ischemic stroke, 14 (30.4%) a hemorrhagic stroke, 1 (2.2%) venous sinus thrombosis and 2 (4.3%) mixed stroke. 11 patients (23.9%) had heart disease and 7 (15.2%) were treated with extracorporeal membrane oxygenation (ECMO) or ventricular assist. 8.6% of patients were treated with fibrinolysis or thrombectomy. 9 patients (19.6%) died. Patients with heart disease and those treated with ECMO had a higher mortality rate. 23 children, 62.1% of survivors, suffered sequelae at discharge. The most frequent sequelae were hemiparesis. Sequelae were significantly more frequent in patients who presented with motor symptoms (76.2%) (p < 0.001).

Conclusions

The frequency of ischemic stroke in pediatric patients is higher than that of hemorrhagic stroke. Pediatric patients who suffer a stroke have a high mortality rate and a high rate of sequelae. Patients with heart disease and those treated with ECMO are those who present stroke most frequently and have a higher mortality rate.