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4 results for “Childhood stroke”
Data from: Socioeconomic determinants of outcome after childhood arterial ischemic stroke
Objective: To determine whether lower socioeconomic status (SES) is associated with worse one-year neurological outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS). Methods: From 2010-2014, Vascular Effects of Infection in Pediatric Stroke observational study prospectively enrolled and confirmed 355 children (29 days -18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars (USD)) at time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure (PSOM) scores were categorized as 0-1, 1.5-3, 3.5-6, 6.5-10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. Results: At 12±3 months post-stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<$10,000 USD), but not other markers of SES, was associated with worse outcomes (OR 3.13, 95% CI:1.43-6.88; p=0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI:1.18-8.47; p=0.02). Income did not correlate with receiving rehabilitation services at one-year post-stroke; however, quality and quantity of services were not assessed. Conclusions: In a large multinational, prospective cohort of children with AIS, low income was associated with worse neurological outcomes when compared to those with higher income levels. This difference was not explained by stroke type, neurological comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear, and warrant further investigation.
Data from: Socioeconomic determinants of outcome after childhood arterial ischemic stroke
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Data from: Comparative study of posterior and anterior circulation stroke in childhood – results from the International Pediatric Stroke Study (IPSS)
Objective: This study compares risk factors, clinical presentation, and outcomes after posterior circulation (PCAIS) and anterior circulation arterial ischemic stroke (ACAIS) in neonates and children. Methods: International multicenter observational study including neonates and children up to 18 years of age with arterial ischemic stroke (AIS), comparing clinical and radiological features according to stroke location. Results: Of 2,768 AIS cases, 507 (18%) were located in the posterior circulation, 1,931 (70%) in the anterior circulation, and 330 (12%) involved both. PCAIS was less frequent in neonates compared to children (8.8% versus 22%, p<0.001). Children with PCAIS were older than children with anterior circulation arterial ischemic stroke (ACAIS), (median age 7.8 (IQR 3.1-14) versus 5.1 (IQR 1.5-12) years, p<0.001), and more often presented with headache (54% versus 32%, p<0.001) and a lower PedNIHSS score (4 (IQR 2-8) versus 8 (IQR 3-13), p=0.001). Cervicocephalic artery dissections (CCAD) were more frequent (20% versus 8.5%, p<0.001), while cardioembolic strokes were less frequent (19% versus 32%, p<0.001) in PCAIS. Case fatality rates were equal in both groups (2.9%). PCAIS survivors had a better outcome (normal neurological examination at hospital discharge in 29% versus 21%, p=0.002) than ACAIS survivors, although this trend was only observed in children and not in neonates. Conclusion: PCAIS is less common than ACAIS in both neonates and children. Children with PCAIS are older, have a higher rate of CCAD, lower clinical stroke severity, and better outcome than children with ACAIS.
Data from: Comparative study of posterior and anterior circulation stroke in childhood – results from the International Pediatric Stroke Study (IPSS)
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