title: Thrombolysis for children with acute ischemic stroke: a perspective from the kids' inpatient database.
abstract: BACKGROUND
  Thrombolysis for acute ischemic stroke (AIS) in children is yet to be proven efficacious, and there is limited information about its safety in large pediatric samples. Here we evaluate the safety outcomes associated with thrombolysis in children as well as the trend of hospital utilization over the past decade in the United States.
  
  
  METHODS
  A cohort of children with acute ischemic stroke was identified from the Kids' Inpatient Database for the years 1998-2009. Acute ischemic stroke was identified by the International Classification of Diseases-9 clinical classification software codes (109 and 110). Multivariate logistic regression analyses were used to assess covariates associated with outcomes of hospital mortality and intracerebral hemorrhage. The Cochran-Armitage test was employed for linear trend of discrete variables.
  
  
  RESULTS
  In this analysis, 9257 children were admitted with the diagnosis of acute ischemic stroke; only 67 (0.7%) received thrombolysis. Thrombolysis-treated children were older than the rest of the cohort (13.1 ± 7.3 vs 8.18 ± 7.5; P < 0.0001) and they had a longer hospital stay (median 11 vs 6 days; P < 0.0001). Gender, race, and family income approximated by postal code were similar among the treated and untreated children. Unadjusted analysis showed higher hospital mortality (10.45% vs 6.14%; P = 0.06) and intracerebral hemorrhage (2.99% vs 0.77%; P = 0.08) in the thrombolysis group. Adjusted analysis showed that intracerebral hemorrhage is predictive of a higher hospital mortality (odds ratio 3.43; 95% confidence interval 1.89-6.22), whereas thrombolysis was not (odds ratio 1.78; 95% confidence interval 0.86-3.64). The overall rate of thrombolysis per 3 years intervals had increased from 5.2 to 9.7 per 1000 children with acute ischemic stroke (P = 0.02). This increase was mainly seen in non-children hospitals (P = 0.01).
  
  
  CONCLUSIONS
  Thrombolysis for acute ischemic stroke is infrequently used in children. There is a trend toward higher risks of intracerebral hemorrhage and hospital mortality, although these risks are as low as those reported in adult population. The hospitals' utilization of thrombolysis in children has increased during the study period.
authors.affiliation: Department of Neurology, Souers Stroke Institute, St. Louis University, St. Louis, Missouri; SSM Neuroscience Institutes, DePaul Health Center, St. Louis University, St. Louis, Missouri; Department of Neurology, St. George's University, Great River, New York. Electronic address: amer_alshekhlee@ssmhc.com.
authors.forename: Amer
authors.initials: A
authors.lastname: Alshekhlee
authors.forename: Thomas
authors.initials: T
authors.lastname: Geller
authors.forename: Sonal
authors.initials: S
authors.lastname: Mehta
authors.forename: Michelle
authors.initials: M
authors.lastname: Storkan
authors.forename: Yasir
authors.initials: Y
authors.lastname: Al Khalili
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007297:Inpatients; D008297:Male; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: children; intracranial hemorrhage; ischemic stroke; outcome; stroke; thrombolysis