Document Detail


High critical care usage due to pediatric stroke: results of a population-based study.
MedLine Citation:
PMID:  22744664     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To measure intensive care unit (ICU) admission, intubation, decompressive craniotomy, and outcomes at discharge in a large population-based study of children with ischemic and hemorrhagic stroke.
METHODS: In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993-2003), we 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.
RESULTS: 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.
CONCLUSIONS: ICU admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression.
Authors:
Christine K Fox; S Claiborne Johnston; Stephen Sidney; Heather J Fullerton
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-27
Journal Detail:
Title:  Neurology     Volume:  79     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-08-01     Completed Date:  2012-10-12     Revised Date:  2014-05-20    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  420-7     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Community Health Planning
Confidence Intervals
Cross-Sectional Studies
Female
Hemorrhage / complications,  therapy
Humans
Infant
Infant, Newborn
Intensive Care Units / standards*,  utilization
Ischemia / complications,  therapy
Male
Odds Ratio
Retrospective Studies
Stroke / epidemiology*,  etiology,  therapy*
Young Adult
Grant Support
ID/Acronym/Agency:
K02 NS053883/NS/NINDS NIH HHS; K12 NS001692/NS/NINDS NIH HHS; K12 NS01692/NS/NINDS NIH HHS
Comments/Corrections
Comment In:
Neurology. 2012 Jul 31;79(5):400-1   [PMID:  22744659 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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