title: High critical care usage due to pediatric stroke: results of a population-based study.
abstract: OBJECTIVE
  To measure intensive care unit (ICU) admission, intubation, decompressive craniotomy, and outcomes at discharge in a large population-based study of children with ischemic and hemorrhagic stroke.
  
  
  METHODS
  In a retrospective study of all children enrolled in a Northern Californian integrated health care plan (1993-2003), we identified cases of symptomatic childhood stroke (age >28 days through 19 years) from inpatient and outpatient electronic diagnoses and radiology reports, and confirmed them through chart review. Data regarding stroke evaluation, management, and outcomes at discharge were abstracted. Intensive care unit (ICU) admission, intubation, and decompressive neurosurgery rates were measured, and multivariate logistic regression was used to identify predictors of critical care usage and outcomes at discharge.
  
  
  RESULTS
  Of 256 cases (132 hemorrhagic and 124 ischemic), 61% were admitted to the ICU, 32% were intubated, and 11% were treated with a decompressive neurosurgery. Rates were particularly high among children with hemorrhagic stroke (73% admitted to the ICU, 42% intubated, and 19% received a decompressive neurosurgery). Altered mental status at presentation was the most robust predictor for all 3 measures of critical care utilization. Neurologic deficits at discharge were documented in 57%, and were less common after hemorrhagic than ischemic stroke: 48% vs 66% (odds ratio 0.5, 95% confidence interval 0.3-0.8). Case fatality was 4% overall, 7% among children admitted to the ICU, and was similar between ischemic and hemorrhagic stroke.
  
  
  CONCLUSIONS
  ICU admission is frequent after childhood stroke and appears to be justified by high rates of intubation and surgical decompression.
authors: Department of Neurology, University of California, San Francisco, CA, USA. foxc@neuropeds.ucsf.edu
authors: Christine K
authors: CK
authors: Fox
authors: S Claiborne
authors: SC
authors: Johnston
authors: Stephen
authors: S
authors: Sidney
authors: Heather J
authors: HJ
authors: Fullerton
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018672:Community Health Planning; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D007511:Ischemia / Q000150:complications / Q000628:therapy; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D055815:Young Adult