Abstract T P322: In-hospital Outcomes of Acute Ischemic Stroke in the Pediatric Population
Objective: To determine trends in tPA utilization, treatment outcomes and predictors of mortality for pediatric patients with acute ischemic stroke.
Materials and Methods: Using the Nationwide Inpatient Sample (NIS) from 2001-2010, pediatric patients (age < 18 years) with the primary diagnosis of ischemic stroke were identified. We studied time trends of utilization of intravenous rtPA and outcomes after thrombolysis. We also analyzed the associations of demographic factors, comorbidities, and complications of acute ischemic stroke with in-hospital mortality.
Results: A total of 7,379 patients were included in this study. In-hospital mortality was 4.5%. The co-morbidities associated with the highest rates of in-hospital mortality were mitochondrial disorders (19.5%, P<0.0001) and hypercoagulable states (10.9%, p<0.0001). The main complications associated with increased mortality were intracranial hemorrhage (19.9%, p<0.0001), sepsis (13.2%, p<0.0001) and pneumonia (9.3%, p=0.0007). tPA utilization rate was 1.3% (99 patients). tPA utilization increased from 0.9% of patients in 2001-2005 to 1.9% of patients in 2006-2010 (P<0.0001). While patients who received tPA did not have higher mortality rates than non-tPA patients (0.0% versus 5.5%, P=0.06), there was an increased discharge-to-long-term-facilities rate in the tPA group (50.8% versus 12.1%, P<0.0001).
Conclusion: Acute ischemic stroke in the pediatric population is associated with a higher mortality rate when related to mitochondriopathies or hypercoagulability. Patients suffering complications such as intracranial hemorrhage, sepsis and pneumonia have higher mortality. rtPA utilization is increasing in pediatric patients with acute ischemic stroke. Pediatric patients receiving tPA have a low risk of fatal hemorrhage. Although patients receiving rtPA have higher rates of morbidity, this may be related to worse stroke severity in these cases.
Author Disclosures: D. Nasr: None. A. Rabinstein: None. W. Brinjikji: None.
- © 2014 by American Heart Association, Inc.