Neurosurgery Blog: National Trends in Utilization and Outcomes of Intravenous Thrombolytic Treatment among Pediatric Patients with Acute Ischemic Stroke in United States (S35.009)

Monday, April 21, 2014

National Trends in Utilization and Outcomes of Intravenous Thrombolytic Treatment among Pediatric Patients with Acute Ischemic Stroke in United States (S35.009)

Neurology recent issues

Background: Thrombolytic treatment has been used with varying frequency among pediatric ischemic stroke patients.Objective: To evaluate trends in utilization of IV recombinant tissue plasminogen activator (rt-PA) and associated rates of death and disability among acute ischemic stroke patients over a six year period.Methods: We obtained data for pediatric patients (aged ≤18 years) admitted to United States in 2003, 2006 and 2009 with a primary diagnosis of ischemic stroke using the Nationwide Inpatient Sample (NIS-KID). We determined the rate and pattern of utilization, and associated in-hospital outcomes of IV-rt-PA including post-thrombolytic intracerebral hemorrhage (ICH) and rates death among pediatric ischemic stroke patients.Results: Of the 5,137 pediatric patients admitted with ischemic stroke, 48 (0.93%) received IV rt-PA during the study period. There was a 2.5 fold increase in rates of patients who received the thrombolytic treatment (0.53% in 2003, 0.87% in 2006 and 1.35% in 2009). The rate of post-thrombolytic ICH was 9.6% with no change in frequency over the three periods. The overall rate of post-thrombolytic intracerebral hemorrhage (ICH) was 9.6% with a trend towards decrease in rates (41%, 9.8%, and 0%) in 2003, 2006, and 2009. The overall rate of in hospital mortality was 9.6% with some decrease in rates (17.2%, 13.0%, and 5.9%, p value for trend=0.7).Conclusion: There has been a significant increase in the proportion of pediatric acute ischemic stroke patients receiving IV rt-PA treatment with some evidence of decrease in adverse outcomes at discharge.

Disclosure: Dr. Reeves has nothing to disclose. Dr. Chaudry has nothing to disclose. Dr. Zafar has nothing to disclose. Dr. Owais has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Jani has nothing to disclose. Dr. Jani has nothing to disclose. Dr. Pawar has nothing to disclose. Dr. Hussain has nothing to disclose. Dr. Qureshi has nothing to disclose.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/S35.009?rss=1