Pediatric stroke affects survivors with lifelong disabilities in motor, cognitive, and behavioral function. Presently, there are no specific treatments for stroke, therefore prevention is exceedingly important. The role of risk factors and how they affect the risk of stroke in large groups of children is not well understood. Recent studies have demonstrated the wide range of risk factors that can predispose a child to arterial ischemic stroke1–3
; however, many of these studies represent case series from a single institution.
There have been few population-based studies, most of relatively small cohorts of children, that examined the proportions of ischemic and hemorrhagic stroke, or the occurrence of stroke risk factors.4–7
One large population-based study in California analyzed stroke subtypes and potential risk factors in 2278 children.8
The study identified race and gender as important risk factors for ischemic and hemorrhagic stroke. In that study, a number of potential risk factors were ranked by their frequency of occurrence; congenital heart disease, arrhythmias, and infections were the 3 most common risk factors. This study demonstrated the value of large population-based studies in comparing the occurrence of ischemic versus hemorrhagic stroke, and in determining the frequency of risk factors in children.
Five studies examined pediatric stroke at the national-level. Steinlin and colleagues determined the incidence, symptoms, and risk factors for 80 Swiss children with arterial ischemic stroke.9
de Veber and colleagues analyzed the incidence, risk factors, and outcome in 160 children with cerebral sinovenous thrombosis in Canada.10
Although these 2 studies examined national-level data, they examined comparatively small groups of children. Fullerton and colleagues analyzed US mortality data in 2 pediatric stroke studies,11,12
and found that racial and geographic factors increased the risk of death from pediatric stroke. Death from stroke, however, represents only a small proportion of children affected by stroke. Recently, Chen and colleagues examined an administrative database of hospital discharges throughout Taiwan.13
Although the data were not presented in detail, stroke incidence was said to be higher in males than females. The incidence of all pediatric strokes was highest in children aged < 4 years, followed by children aged 15 to 19 years.
Given the many gaps in our knowledge regarding pediatric stroke, larger population-based studies of pediatric stroke are needed. Such large population-based studies are difficult to perform because of the low incidence of pediatric stroke. One alternative is to use national administrative databases to examine gender, stroke subtype, and concurrent diagnoses for significant numbers of children who had stroke. For these reasons we analyzed a subset of the Nationwide Inpatient Survey, called KID2003, to determine the frequency of ischemic and hemorrhagic stroke discharge, and to determine associated risk factors in children in the United States.