Predicting recovery and outcome after pediatric stroke

Ryan J. Felling,  Mubeen F. Rafay,  Timothy J. Bernard,  Jessica L. Carpenter  Nomazulu Dlamini  Sahar M. A. Hassanein  Lori C. Jordan  Michael, J. Noetzel,  Michael J. Rivkin, Kevin A. Shapiro,  Mahmoud Slim,  Gabrielle de Veber,  International Pediatric Stroke Study Group.  Predicting Recovery and Outcome After Pediatric Stroke: Results from the International Pediatric Stroke Study.  Ann Neurol First published:25 March 2020 https://doi.org/10.1002/ana.25718

Abstract

Objective

To characterize predictors of recovery and outcome following pediatric arterial ischemic stroke, hypothesizing that age influences recovery after stroke.    

Methods

We studied children enrolled in the International Pediatric Stroke Study between January 1, 2003 and July 31, 2014 with two-year follow-up after arterial ischemic stroke.  Outcomes were defined at discharge by clinician grading and at two years by Pediatric Stroke Outcome Measure (PSOM).  Demographic, clinical, and radiologic outcome predictors were examined.  We defined changes in outcome from discharge to two years as recovery (improved outcome), emerging deficit (worse outcome), or no change.   

Results

Our population consisted of 587 patients, including 174 with neonatal stroke and 413 with childhood stroke, with recurrent stroke in 8.2% of childhood patients.  Moderate to severe neurological impairment was present in 9.4% of neonates vs 48.8% of children at discharge compared to 8.0% vs 24.7% after two years.  Predictors of poor outcome included age between 28 days and one year (compared to neonates, OR 3.58, p<0.05), underlying chronic disorder (OR 2.23, p<0.05), and involvement of both small and large vascular territories (OR 2.84, p<0.05).  Recovery patterns differed, with emerging deficits more common in children under one year of age (p<0.05). 

Interpretation

Outcomes after pediatric stroke are generally favorable, but moderate to severe neurological impairments are still common.  Age between 28 days and one year appears to be a particularly vulnerable period.  Understanding the timing and predictors of recovery will allow us to better counsel families and target therapies to improve outcomes after pediatric stroke.

Courtesy of:  https://www.mdlinx.com/journal-summaries/stroke/2020/03/27/7631990?spec=neurology