Temporal Trends in the Incidence and Case Fatality of Stroke in Children and Adolescents

Abstract

A recent study reported that mortality from stroke in children and adolescents decreased by 58% from 1979 to 1998, although it wasn't clear if the case fatality or the incidence of stroke in this age group is decreasing. We report trends of stroke incidence and case fatality in children and adolescents within a large biracial population. The study involved collection of all strokes in the study population between January 1, 1988 and December 31, 1989, July 1, 1993 and June 30, 1994, and January 1, 1999 and December 31, 1999, at all of the regional hospitals serving the Greater Cincinnati/Northern Kentucky population (only the children's hospital in 1988). Study nurses reviewed the medical records of all inpatients with stroke-related discharge diagnoses and abstracted relevant data. A study physician reviewed each abstract to determine whether a stroke or transient ischemic attack had occurred. A total of 54 strokes occurred in children or adolescents younger than 20 years during the three study periods (30% African American, 70% Caucasian, and 56% female). The overall incidence rate of all strokes in children younger than 15 years was 6.4/100,000 in 1999, a nonsignificant increase when compared to 1988. The 30-day case-fatality rates were 18% in 1988—1989, 9% in 1993—1994, and 9% in 1999. We found that the incidence of strokes in children has been stable over the past 10 years. The previously reported nationwide decrease in overall stroke mortality in children might be due to decreasing case fatality after stroke and not decreasing stroke incidence. Based on our data, we conservatively estimated that approximately 3000 children less than 20 years old would have a stroke in the United States in 2004. (J Child Neurol2006;21:415—418; DOI 10.2310/7010.2006.00091).

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References

Broderick J. , Talbot G. , Prenger E. , et al: Stroke in children within a major metropolitan area: The surprising importance of intracerebral hemorrhage. J Child Neurol 1993;8:250—255.

Schoenberg BS , Mellinger JF , Schoenberg DG : Cerebrovascular disease in infants and children: A study of incidence, clinical features, and survival. Neurology 1978;28:763—768.

Fullerton HJ , Chetkovich DM , Wu YW , et al: Deaths from stroke in US children, 1979 to 1998. Neurology 2002;59:34—39.

Broderick J. , Brott T. , Kothari R. , et al: The Greater Cincinnati/Northern Kentucky Stroke Study: Preliminary first-ever total incidence rates of stroke among blacks. Stroke 1998;29:415—421.

Broderick J. , Brott T. , Tomsick T. , et al: The risk of subarachnoid and intracerebral hemorrhages in blacks as compared with whites. N Engl J Med 1992;326:733—736.

International Classification of Diseases, Ninth Revision, Clinical Modification. American Medical Association Press, 2002.

National Institute of Neurological Diseases and Stroke : Classification of neurological disorders III . Stroke 1990;21:637—676.

Brown R. , Whisnant J. , Sicks J. , et al: Stroke incidence, prevalence, and survival: Secular trends in Rochester, Minnesota, through 1989. Stroke 1996;27:373—380.

Earley CJ , Kittner SJ , Feeser BR , et al: Stroke in children and sickle-cell disease: Baltimore-Washington Cooperative Young Stroke Study. Neurology 1998;51:169—176.

10.

Bleyer WA : Epidemiologic impact of children with brain tumors. Childs Nerv Syst 1999;15:758—763.

11.

Kissela B. , Schneider A. , Kleindorfer D. , et al: Stroke in a biracial population: The excess burden of stroke among blacks. Stroke 2004;35:426—431.

12.

Fullerton HJ , Wu YW , Zhao S. , Johnston SC : Risk of stroke in children: Ethnic and gender disparities. Neurology 2003;61:189—194.

13.

Kittner S. , Cole JW , Jebel JR , et al: Black-white differences in stroke risk: The Baltimore-Washington Cooperative Young Stroke Study, abstract. Stroke 2003;34:288.

14.

Kirkham FJ , Hogan AM : Risk factors for arterial ischemic stroke in childhood. CNS Spectr 2004;9:451—464.

15.

Ganesan V. , Prengler M. , McShane MA , et al: Investigation of risk factors in children with arterial ischemic stroke. Ann Neurol 2003;53:167—173.

16.

Giroud M. , Lemesle M. , Gouyon JB , et al: Cerebrovascular disease in children under 16 years of age in the city of Dijon, France: A study of incidence and clinical features from 1985 to 1993. J Clin Epidemiol 1995;48:1343—1348.

17.

deVeber G. , Andrew M. : Cerebral sinovenous thrombosis in children. N Engl J Med 2001;345:417—423.

18.

Lynch JK , Hirtz DG , DeVeber G, Nelson KB : Report of the National Institute of Neurological Disorders and Stroke Workshop on Perinatal and Childhood Stroke. Pediatrics 2002;109:116—123.

19.

Fullerton HJ , Johnston SC , Smith WS : Arterial dissection and stroke in children . Neurology 200 1;57:1155-1160.