High critical care usage due to pediatric stroke-Results of a population-based study
Fox CK et al. – Intensive care unit (ICU) admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression.Methods
- In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993-2003), the authors identified cases of symptomatic childhood stroke (age >28 days through 19 years) from inpatient and outpatient electronic diagnoses and radiology reports, and confirmed them through chart review.
- Data regarding stroke evaluation, management, and outcomes at discharge were abstracted.
- Intensive care unit (ICU) admission, intubation, and decompressive neurosurgery rates were measured, and multivariate logistic regression was used to identify predictors of critical care usage and outcomes at discharge.
- Of 256 cases (132 hemorrhagic and 124 ischemic), 61% were admitted to the ICU, 32% were intubated, and 11% were treated with a decompressive neurosurgery.
- Rates were particularly high among children with hemorrhagic stroke (73% admitted to the ICU, 42% intubated, and 19% received a decompressive neurosurgery).
- Altered mental status at presentation was the most robust predictor for all 3 measures of critical care utilization.
- Neurologic deficits at discharge were documented in 57%, and were less common after hemorrhagic than ischemic stroke: 48% vs 66% (odds ratio 0.5, 95% confidence interval 0.3-0.8).
- Case fatality was 4% overall, 7% among children admitted to the ICU, and was similar between ischemic and hemorrhagic stroke.