Pediatric neurology. 2025 May 15:169:123-130. doi: 10.1016/j.pediatrneurol.2025.05.015 Q23.22024

Factors Influencing Long-Term Outcomes in Childhood Arterial Ischemic Stroke

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Nicola D Fearn¹, Maggie L Yau², Jay Gajera³, Paul Monagle⁴, Anneke Grobler⁵, Belinda Stojanovski⁶, Vicki Anderson⁷, Anne Gordon⁸, Mardee Greenham⁹, Anna Cooper¹⁰, Mark T Mackay¹¹

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作者单位

¹ Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia. Electronic address: nicola.fearn@rch.org.au.

² Department of Paediatrics, Prince of Wales Hospital, Sha Tin, Hong Kong.

³ Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

⁴ Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Clinical Haematology, Royal Children's Hospital, Parkville, Victoria, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia.

⁵ Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

⁶ Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.

⁷ Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia.

⁸ Department of Neurosciences, King's College, London, United Kingdom; Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom.

⁹ Murdoch Children's Research Institute, Parkville, Victoria, Australia.

¹⁰ Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.

¹¹ Department of Neurology, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.

DOI: 10.1016/j.pediatrneurol.2025.05.015 PMID: 40499242

摘要 Ai翻译

Background: Childhood arterial ischemic stroke (AIS) is associated with substantial long-term morbidity. This study aims to describe factors associated with recurrence, mortality, and neurological disability.

Methods: Australian children with radiologically confirmed AIS were enrolled prospectively to the Royal Children's Hospital stroke registry from 2003 to 2017. Data collected included demographics, clinical and radiological variables, Pediatric National Institutes of Health Stroke Scale severity score, and the Childhood AIS Standardized Classification and Diagnostic Evaluation etiology. Neurological outcomes were categorized as good (normal) or poor (mild/moderate/severe) using the Pediatric Stroke Outcome Measure Severity Classification Scheme.

Results: A total of 172 children with AIS were identified; 11% died (2% stroke-related), 15% had recurrent strokes (5% transient ischemic attacks), and 8% developed epilepsy. Pediatric Stroke Outcome Measure follow-up data were available for 131 children at a median 8.9 years of follow-up (interquartile range, 6.0-11.9). Risk factors for recurrence were arteriopathy (hazard ratio [HR], 2.75; confidence interval [CI], 1.47-5.15, P = 0.002) and hemiparesis (HR, 1.34; CI, 1.07-1.69, P = 0.012); 43% of children had poor long-term outcomes, which were associated with altered conscious state (odds ratio [OR], 2.79; CI, 1.25-6.22, P = 0.012) and neurosurgical intervention (OR, 3.20; CI, 1.55-6.59, P = 0.002).

Conclusions: Long-term neurological deficits are common in children with AIS in the prereperfusion therapy era. The use of pediatric-specific stroke assessment measures and etiologic classification systems enables this study to be a comparator for future stroke studies, measuring the impact of reperfusion therapies on outcomes in childhood AIS.

Keywords: Neurological impairment; Pediatric; Recurrence; Risk factors; Stroke.

期刊名：Pediatric neurology

缩写：PEDIATR NEUROL

ISSN：0887-8994

e-ISSN：1873-5150

IF/分区：3.2/Q2

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