title: Recent trauma and acute infection as risk factors for childhood arterial ischemic stroke.
abstract: OBJECTIVE
  Trauma and acute infection have been associated with stroke in adults, and are prevalent exposures in children. We hypothesized that these environmental factors are independently associated with childhood arterial ischemic stroke (AIS).
  
  
  METHODS
  In a case-control study nested within a cohort of 2.5 million children (≤19 years old) enrolled in an integrated health care plan (1993-2007), childhood AIS cases (n = 126) were identified from electronic records and confirmed through chart review. Age- and facility-matched controls (n = 378) were randomly selected from the cohort. Exposures were determined from review of medical records prior to the stroke diagnosis, or the same date for the paired controls; time windows were defined a priori.
  
  
  RESULTS
  A medical encounter for head or neck trauma within the prior 12 weeks was an independent risk factor for childhood AIS (odds ratio [OR], 7.5; 95% confidence interval [CI], 2.9-19.3), present in 12% of cases (1.6% of controls). Median time from trauma to stroke was 0.5 days (interquartile range, 0-2 days); post hoc redefinition of trauma exposure (prior 1 week) was more strongly associated with AIS: OR, 39; 95% CI, 5.1-298. A medical encounter for a minor acute infection (prior 4 weeks) was also an independent risk factor (OR, 4.6; 95% CI, 2.6-8.2), present in 33% of cases (13% of controls). No single infection type predominated. Only 2 cases had exposure to trauma and infection.
  
  
  CONCLUSIONS
  Trauma and acute infection are common independent risk factors for childhood AIS, and may be targets for stroke prevention strategies.
authors.affiliation: Department of Neurology, University of California at San Francisco, CA 94143, USA.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Hills
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Zielinski
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018672:Community Health Planning; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D004781:Environmental Exposure / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008297:Male; D019838:Neck Injuries / Q000453:epidemiology*; D016017:Odds Ratio; D010372:Pediatrics; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D014947:Wounds and Injuries / Q000453:epidemiology*