LOS ANGELES – A large population-based study found better outcomes a year after childhood arterial ischemic stroke than were reported in previous studies that analyzed hospital-based cohorts.
The prospective Study of Outcome in Childhood Stroke (SOCS) followed cases of arterial ischemic stroke in children older than 27 days and younger than 16 years that were identified by British networks of medical specialists and surveillance databases from July 2008 through June 2009. The data collected cover 6 million children – 63% of children in England.
They found 82 cases of arterial ischemic stroke, for an incidence of 1.4/100,000 children per year, Dr. Andrew A. Mallick reported. Consent for follow-up assessments in the study was not available for seven patients, and six died (though none died primarily of stroke).
The parents of the remaining 69 children completed the International Pediatric Stroke Study Recovery and Recurrence Questionnaire. Their answers suggested that 32 (46%) children had fully recovered from the stroke and that 46 (67%) needed no extra help in daily activities.
Physician assessments using the Pediatric Stroke Outcome Measure suggested that 45% of the children were normal with no stroke-related deficits a year later. In the rest, physicians rated the severity of deficits as mild in 10% of children, moderate in 20%, and severe in 25%, said Dr. Mallick of the University of Bristol (England).
The percentages of children in the SOCS rated as fully recovered by parents and physicians compares favorably with the largest and most-often cited previous studies of outcome after childhood stroke, he said at the meeting, sponsored by the American Heart Association. Those studies reported normal function after arterial ischemic stroke in 32% and 13% of children (J. Child Neurol. 2000;15:316-24; Dev. Med. Child Neurol. 2000;42:455-61).
The previous studies followed patients from tertiary care children’s hospitals in Canada and England. Hospital-based registries generally include patients with more severe strokes who are at a higher risk of complications or death, he said.
The SOCS findings should affect prognosis after childhood arterial ischemic stroke and the design of clinical trials, Dr. Mallick said.
"We’ve seen from our data that almost half the children are prepared to make a full recovery. If some of the proposed therapies are relatively high risk, I think we need to carefully consider whether we want to be giving children who are going to recover anyway such potentially dangerous therapies," he said.
When neurologic deficits were seen in the SOCS, about half were sensorimotor deficits, approximately a quarter were cognition or behavioral deficits, and fewer were deficits in expressive or receptive speech, Dr. Mallick and his associates found.
He said he and his coinvestigators had no relevant financial disclosures. The Stroke Association (United Kingdom) funded the study.