Authors (including presenting author) :
Fan CCY(1), Wang Y(1)(2), Leung LK(1), Tso WWY(1)(3)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, (2) Department of Psychology, The University of Hong Kong, (3) State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
Introduction :
Pediatric stroke is one of the prominent causes of long-term neurological impairments in children, and it can be further divided into perinatal and childhood stroke. These two stroke types can be distinguished based on the time of occurrence. Perinatal stroke encompasses cerebrovascular events that occur from birth to 28 days of age, while childhood stroke refers to events that happen between 29 days and 18 years old. This study describes the prevalence and post-stroke outcomes of the pediatric population in Hong Kong with childhood stroke.
Objectives :
This population-based retrospective cohort study aims to (1) investigate the prevalence rates of childhood stroke and post-stroke outcome in Hong Kong from 2006 to 2020, (2) examine the risk factors associated with adverse outcomes, and (3) assess the risk of adverse motor, cognitive, speech/language, and neuropsychiatric outcomes in children with childhood stroke.
Methodology :
We conducted a population-based retrospective cohort study on childhood stroke by analyzing clinical data from the 2006 to 2020 birth cohorts in Hong Kong. We identified cases of childhood stroke using the following ICD-9 codes: 430 (Subarachnoid hemorrhage), 431 (Intracerebral hemorrhage), 433 (Occlusion and stenosis of precerebral arteries), 434 (Occlusion of cerebral arteries), 435 (Transient cerebral ischemia), and 437 (Other and ill-defined cerebrovascular disease). Using ICD-9 codes to indicate related disorders and impairments, we identified stroke outcomes in motor, cognitive, neuropsychiatric, and speech/language aspects among the selected stroke cases. We also utilized allied health service utility data, including physiotherapy, occupational therapy, speech therapy, and clinical psychology, to assess and identify the outcomes. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) between age of stroke onset and post-stroke adverse outcomes.
Result & Outcome :
From 2006 to 2020, there were 49 (33.1%) cases of arterial ischemic stroke, and 98 (66.2%) cases of hemorrhagic stroke. Among the children with stroke, 105 children presented with motor deficits, 18 children presented with cognitive deficits, 57 children presented with neuropsychiatric deficits, and 67 children presented with speech/language deficits. Cox regression analyses revealed that age of stroke was significantly associated with an increased risk for adverse motor (adjusted HR, 1.69 [95% CI 1.04,2.75]) and neuropsychiatric (2.96 [1.39,6.32]).Over half of the children with stroke suffer from motor deficits. In addition, a high proportion of children with stroke also suffer from speech/ language, neuropsychiatric and cognitive deficits. Our findings demonstrate a significant correlation between the age of stroke diagnosis and the probability of experiencing unfavorable functional outcomes. Additional research is required to gain a more comprehensive understanding of the functional abilities of children with stroke. This knowledge is necessary to create effective interventions and rehabilitation approaches that can improve their quality of life and long-term outcomes.
