The International Pediatric Stroke Study: Insight into Childhood Stroke from a Developmental Perspective.

Abstract

To determine if children enrolled in the International Pediatric Stroke Study (IPSS) database (4294 patients enrolled, 2003-2014, neonates through 18 years of age) demonstrate demographic, clinical, radiographic, and therapeutic characteristics that relate to age and development at the time of stroke. Participants with arterial ischemic stroke or cerebral sinus venous thrombosis were enrolled using standardized consent and case report forms. Data were entered on-site and electronically transferred to a central data storage site in Toronto, Canada. Children were stratified into 4 age groups for analysis of developmental features: neonates (0-28 days of age); infants (29 days to <2 years of age); young children (2 years to <10 years old), and adolescents (≥10 years to <18 years old). Continuous and categorical variables were examined using appropriate statistical techniques in SAS (SAS Institute, Inc). Three thousand eight-hundred nine children were analyzed: 1112 (29.2%) neonates, 728 (19.1%) infants, 1088 (28.6%) young children, and 881 (23.1%) adolescents. Arterial ischemic stroke alone occurred in 3201 (916 neonates; 2285 older children) and cerebral sinovenous thrombosis alone occurred in 608 (196 neonates; 412 older children). Age group specific clinical and neuroimaging features that segregate by ischemic stroke type were identified and are reported. The IPSS database comprises a very large, structured pediatric stroke database used by investigators to advance the understanding and treatment of pediatric stroke. Developmentally based analyses of IPSS data reveal features of childhood stroke that segregate by ischemic stroke type and age at stroke occurrence. These features should aid in understanding age-related pathophysiology and in clinical stroke recognition.