Introduction: Pediatric stroke occurs in up to 13 out of every 100,000 children and often results in lifelong disability or mortality. The purpose of our study was to identify factors that affect hospital length of stay (LOS), total costs, and in-hospital mortality in pediatric ischemic stroke hospitalizations.
Methods: We queried the Nationwide Inpatient Sample from 2002 to 2011 to identify all hospitalizations (age 1-17) for pediatric ischemic stroke. Bivariate and multivariate (adjusted for all covariates) analyses were utilized to determine the effect of demographics, insurance status, and preexisting comorbidities on the rates of secondary intracerebral hemorrhage (ICH), prolonged LOS (≥ 90th percentile for LOS), increased hospital costs (≥ 90th percentile for costs), and mortality.
Results: A total of 6,303 hospitalizations for pediatric ischemic stroke were identified. The rates of thrombolytic therapy and mechanical thrombectomy (years 2008-2011, N=2,409) were 1.67% and 1.41%, respectively. Multivariate adjusted risk factors for secondary ICH during hospitalization included: black race (odds ratio [OR], 1.99), minority race (OR: 2.47), 2 or more pre-existing comorbidities (OR: 2.31), and moyamoya disease (OR: 4.35; all P Values <0.05). Adjusted predictors of mortality included: secondary ICH (OR: 9.98), Medicaid insurance (OR: 1.38), 2 or more preexisting comorbidities (OR: 5.31), and southern region (OR: 2.08; all P Values <0.05). Furthermore, patients with pre-existing hypercoagulability (OR: 1.77) or autoimmune disorders (OR: 2.38), faced greater mortality than those with congenital heart disease (OR: 0.55) or sickle cell disease (OR: 0.47; all P Values <0.05). Minority race, small hospital bedsize, and increased comorbidity increased the odds of both prolonged LOS and increased costs (all P Values <0.0001). Medicaid insurance, southern region, and urban hospital location increased the odds of prolonged LOS, whereas, teaching hospitals and weekend admission resulted in increased costs (all P Values <0.05).
Conclusion: The in-hospital outcomes of pediatric stroke patients are significantly impacted by socioeconomic factors, hospital characteristics, and underlying disease etiologies.