Abstract
Background
Thrombolysis for acute ischemic stroke (AIS) in children is yet to be proven efficacious,
and there is limited information about its safety in large pediatric samples. Here
we evaluate the safety outcomes associated with thrombolysis in children as well as
the trend of hospital utilization over the past decade in the United States.
Methods
A cohort of children with acute ischemic stroke was identified from the Kids' Inpatient
Database for the years 1998-2009. Acute ischemic stroke was identified by the International
Classification of Diseases-9 clinical classification software codes (109 and 110).
Multivariate logistic regression analyses were used to assess covariates associated
with outcomes of hospital mortality and intracerebral hemorrhage. The Cochran-Armitage
test was employed for linear trend of discrete variables.
Results
In this analysis, 9257 children were admitted with the diagnosis of acute ischemic
stroke; only 67 (0.7%) received thrombolysis. Thrombolysis-treated children were older
than the rest of the cohort (13.1 ± 7.3 vs 8.18 ± 7.5; P < 0.0001) and they had a longer hospital stay (median 11 vs 6 days; P < 0.0001). Gender, race, and family income approximated by postal code were similar
among the treated and untreated children. Unadjusted analysis showed higher hospital
mortality (10.45% vs 6.14%; P = 0.06) and intracerebral hemorrhage (2.99% vs 0.77%; P = 0.08) in the thrombolysis group. Adjusted analysis showed that intracerebral hemorrhage
is predictive of a higher hospital mortality (odds ratio 3.43; 95% confidence interval
1.89-6.22), whereas thrombolysis was not (odds ratio 1.78; 95% confidence interval
0.86-3.64). The overall rate of thrombolysis per 3 years intervals had increased from
5.2 to 9.7 per 1000 children with acute ischemic stroke (P = 0.02). This increase was mainly seen in non-children hospitals (P = 0.01).
Conclusion
Thrombolysis for acute ischemic stroke is infrequently used in children. There is
a trend toward higher risks of intracerebral hemorrhage and hospital mortality, although
these risks are as low as those reported in adult population. The hospitals’ utilization
of thrombolysis in children has increased during the study period.
Keywords
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Article info
Publication history
Accepted:
August 14,
2013
Received:
May 20,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
