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A NATIONAL, POPULATION BASED STUDY OF PEDIATRIC HEMORRHAGIC AND ISCHEMIC STROKE
Background and Aims
Stroke is an important cause of morbidity and mortality in pediatrics and large studies are needed at both academic and non-academic hospitals to better understand the pathogenesis of pediatric stroke. Large administrative datasets can provide information on risk factors in neonatal and pediatric stroke.
The data for patients aged 0-18 with a diagnosis of either ischemic or hemorrhagic stroke were extracted from the Cerner Health Facts EMR Database from 2000-2018. Patients were subdivided by age. The prevalence of established risk factors for pediatric stroke was assessed amongst the extracted cases.
10,621 children were identified with stroke. 6,271(59%) were ischemic and 4,350(41%) were hemorrhagic. The percentage of combined stroke by age were 33%(<1 year), 20%(1-4 years), 14%(5-9 years), 11%(10-13 years), and 22%(14-18 years). The most frequently identified risk factors for ischemic stroke were hypertension(36%), trauma(27%), hyperlipidemia(26%) and malignancy(19%). Moyamoya(3%), congenital heart disease(5%), and dissection(1%) were rare in this dataset. The most common risk factors seen with hemorrhagic stroke were trauma(55%), malignancy(11%), arrhythmia(10%) and hypertension(9%).
This is the largest retrospective study of pediatric stroke of its kind from hospitals across the US in both academic and non-academic clinical settings. Many traditional adult risk factors for stroke are prevalent in pediatric patients with ischemic and hemorrhagic stroke, while common comorbidities in pediatric stroke diagnosed in academic centers, such as Moyamoya, congenital heart disease, and coagulation defects are less frequently diagnosed. A prior diagnosis of trauma and malignancy are prevalent in pediatric patients with both ischemic and hemorrhagic stroke.