Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Gerardo Garza-Alatorre; Ana Luisa Carrion-Garcia; Alfredo Falcon-Delgado; Elda Carolina Garza-Davila; Angel R Martinez-Ponce de Leon; Edgar Botello-Hernandez

doi:10.1055/s-0041-1731802

Neuropediatrics, Table of Contents

Neuropediatrics 2021; 52(06): 499-503
DOI: 10.1055/s-0041-1731802

Short Communication

Characteristics of Pediatric Stroke and Association of Delayed Diagnosis with Mortality in a Mexican Tertiary Care Hospital

Gerardo Garza-Alatorre

¹Pediatric Intensive Therapy Unit, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

²Pediatrics Department, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

,

Ana Luisa Carrion-Garcia

²Pediatrics Department, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

,

Alfredo Falcon-Delgado

²Pediatrics Department, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

,

Elda Carolina Garza-Davila

²Pediatrics Department, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

,

Angel R Martinez-Ponce de Leon

³Neurosurgery and Endovascular Neurological Therapy Department, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

,

Edgar Botello-Hernandez

⁴Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico

› Author Affiliations

Abstract

Background and objectives Pediatric cerebrovascular disease carries significant morbidity and mortality. Early recognition of a pediatric stroke as well and its most common risk factors are important, but that diagnosis is often delayed. It is believed that the incidence in our center is higher than it appears. This study aims to assess the incidence and characteristics of the pediatric stroke in our university hospital. Likewise, this study seeks to evaluate if a longer symptoms-to-diagnosis time is associated with mortality in patients with ischemic stroke.

Methods A retrospective study including children with stroke admitted to the UANL University Hospital from January 2013 to December 2016.

Results A total of 41 patients and 46 stroke episodes were admitted. About 45.7% had an ischemic stroke and 54.3% had a hemorrhagic stroke. A mortality of 24.4% and a morbidity of 60.9% were recorded. Regarding ischemic and hemorrhagic stroke, an increased symptoms-to-diagnosis time and a higher mortality were obtained with a relative risk of 2.667 (95% confidence interval [CI]: 1.09–6.524, p = 0.013) and 8.0 (95% CI: 2.18–29.24, p = < 0.0001), respectively. A continuous increase in the incidence rate, ranging from 4.57 to 13.21 per 1,000 admissions comparing the first period (2013) versus the last period (2016), p = 0.02, was found in our center.

Conclusions Pediatric stroke is a rare disease; however, its incidence shows a continuous increase. More awareness toward pediatric stroke is needed.

Keywords

pediatric - stroke - incidence - mortality - morbidity - diagnosis

Full Text

References

References
1 Campbell BCV, De Silva DA, Macleod MR. et al. Ischaemic stroke. Nat Rev Dis Primers 2019; 5 (01) 70
2 Schoenberg BS, Mellinger JF, Schoenberg DG. Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival. Neurology 1978; 28 (08) 763-768
3 Felling RJ, Sun LR, Maxwell EC, Goldenberg N, Bernard T. Pediatric arterial ischemic stroke: epidemiology, risk factors, and management. Blood Cells Mol Dis 2017; 67: 23-33
4 Jordan LC, Hillis AE. Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol 2011; 7 (04) 199-208
5 Jeong G, Lim BC, Chae J-H. Pediatric stroke. J Korean Neurosurg Soc 2015; 57 (06) 396-400
6 Mackay MT, Wiznitzer M, Benedict SL, Lee KJ, Deveber GA, Ganesan V. International Pediatric Stroke Study Group. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol 2011; 69 (01) 130-140
7 Rajani NK, Pearce K, Campion T. et al. Pediatric stroke: current diagnostic and management challenges. Quant Imaging Med Surg 2018; 8 (10) 984-991
8 Krishnamurthi RV, deVeber G, Feigin VL. et al; GBD 2013 Stroke Panel Experts Group. Stroke prevalence, mortality and disability-adjusted life years in children and youth aged 0–19 years: data from the global and regional burden of stroke 2013. Neuroepidemiology 2015; 45 (03) 177-189
9 Morales-García D, Garza-Mercado R, Martínez-Ponce de León A. et al. Hemorrhagic stroke in children. Arch Neurocien 2010; 15 (04) 205-210
10 Ganesan V. Outcome and rehabilitation after childhood stroke. Handb Clin Neurol 2013; 112: 1079-1083
11 Fullerton HJ, Wu YW, Sidney S, Johnston SC. Risk of recurrent childhood arterial ischemic stroke in a population-based cohort: the importance of cerebrovascular imaging. Pediatrics 2007; 119 (03) 495-501
12 Greenham M, Gordon A, Anderson V, Mackay MT. Outcome in childhood stroke. Stroke 2016; 47 (04) 1159-1164
13 Perkins E, Stephens J, Xiang H, Lo W. The cost of pediatric stroke acute care in the United States. Stroke 2009; 40 (08) 2820-2827
14 Griesman JD, Karahalios DS, Prendergast CJ. Hematologic changes in cyanotic congenital heart disease: a review. Prog Pediatr Cardiol 2020; 56: 101193
15 Ferriero DM, Fullerton HJ, Bernard TJ. et al; American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke 2019; 50 (03) e51-e96