Stroke in the pediatric intensive care unit.

Abstract

Objectives: To analyze the frequency, causes, risk factors, mortality and sequelae of stroke in children admitted to the pediatric intensive care unit (PICU).

Design: Single-center retrospective observational study based on a prospective database.

Setting: Pediatric intensive care unit.

Patients: Children between one month and eighteen years of age admitted to the PICU and diagnosed with stroke were included.

Main variables of interest: Epidemiological, clinical, diagnostic and treatment data, sequelae and mortality were recorded.

Interventions: None.

Results: 46 patients were studied, of whom 29 (63%) had an ischemic stroke, 14 (30.4%) a hemorrhagic stroke, 1 (2.2%) venous sinus thrombosis and 2 (4.3%) mixed stroke. 11 patients (23.9%) had heart disease and 7 (15.2%) were treated with extracorporeal membrane oxygenation (ECMO) or ventricular assist. 8.6% of patients were treated with fibrinolysis or thrombectomy. 9 patients (19.6%) died. Patients with heart disease and those treated with ECMO had a higher mortality rate. 23 children, 62.1% of survivors, suffered sequelae at discharge. The most frequent sequelae were hemiparesis. Sequelae were significantly more frequent in patients who presented with motor symptoms (76.2%) (p < 0.001).

Conclusions: The frequency of ischemic stroke in pediatric patients is higher than that of hemorrhagic stroke. Pediatric patients who suffer a stroke have a high mortality rate and a high rate of sequelae. Patients with heart disease and those treated with ECMO are those who present stroke most frequently and have a higher mortality rate.