Pediatric Stroke Trends

Source: George MG, Tong X, Kuklina EV, et al. Trends in stroke hospitalizations and associated risk factors among children and young adults, 1995-2008. Ann Neurol. 2011;70(11):713-721; doi:10.1002/ana.22539. See AAP Grand Rounds commentary by Dr. Gordon Millichap (subscription required).

PICO
Question: Among children and young adults, what are the recent trends in stroke hospitalization rates and stroke risk factors?
Question type: Descriptive
Study design: Retrospective observational

Investigators from the Centers for Disease Control and Prevention looked at trends in stroke hospitalizations from 1995 to 2008 among children and young adults. They also commented on associations of stroke risk factors with these trends. Key findings were an overall increase in acute ischemic stroke hospitalizations as well as an increase in traditional stroke risk factors such as hypertension, diabetes, obesity, lipid disorders, and tobacco use. An increasing trend in alcohol abuse as an associated factor in males 15-34 years of age with ischemic stroke was noted, along with increasing trends in alcohol abuse and non-alcohol drug abuse in both males and females 35-44 years of age. Of course, many of these risk factors can be modified with healthy behaviors, suggesting a path for future preventive efforts.

The database used by these investigators is the Nationwide Inpatient Sample (NIS), supported by a partnership among federal and state govermenments and private industry. It began in 1988 with data from eight states and now (2009) includes 44 states. Anyone can access the information for a modest (actually cheap!) fee and signed agreement with NIS policies. The database is particularly well-suited for studies on healthcare policy and services research. Of course, databases of this type can only yield retrospective data analyses, and the depth of data is not deep and is affected by variations in how data are collected across over 1000 hospitals. For example, the investigators in this study could not ascertain oral contraceptive use from the database, and thus could not comment on how this well-known risk factor might contribute to stroke in children and young adults.

Stroke is a devastating condition, with significant mortality as well as life-long morbidity among survivors. Certainly this will improve with advances in diagnosis and treatment, but preventive measures represent perhaps the most valuable avenue for improving outcomes.