Critical care needs high in childhood stroke

By Eleanor McDermid

Children with stroke frequently require admission to the intensive care unit (ICU), show findings from a population-based study.

The researchers found that 61% of children required ICU admission, similar to that reported for adult stroke patients. Of all 256 children in the study, 32% were intubated and 11% underwent decompressive surgery.

"While the high critical care utilization we observed could reflect either severity of illness or medical providers' discomfort with an uncommon diagnosis, our findings suggest that children with stroke have true critical care needs," say Christine Fox (University of California, San Francisco, USA) and co-workers.

The children, who were identified from among 2.3 million in a Californian medical care program, had 132 hemorrhagic and 124 ischemic strokes - a higher proportion of hemorrhagic strokes than would be seen in adults.

Critical care needs were particularly high among children with a hemorrhagic stroke, with 73% requiring ICU admission, 42% being intubated, and 19% undergoing decompressive surgery.

Yet fewer children with hemorrhagic than ischemic stroke had persistent neurologic deficits at discharge, at 48% versus 66%. However, the researchers stress that the high overall rate of deficits at discharge support their contention that many children with stroke are critically ill. The case-fatality rate was 4% overall and 7% for children admitted to the ICU.

The only factor to predict all three of the team's critical care measures was altered consciousness at presentation, which raised the risk for ICU admission 4.7-fold, for intubation 15.3-fold, and for decompressive surgery 14.0-fold.

"This study is a novel assessment of childhood stroke care and is a step toward recognizing the importance of optimizing critical care after pediatric stroke," Fox et al write in Neurology.

They remark: "It is unknown whether specialized pediatric neurocritical care would improve childhood stroke outcomes, but the high rates of critical care utilization and poor outcomes in our cohort suggest that research focused on the critical care management of childhood stroke would be vital to the care of the majority of these patients and support a need for further studies in this area."

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