Background
Evidence regarding the risk factors and reperfusion therapies associated with hemorrhagic transformation(HT) following acute ischemic stroke(AIS) in adults is well-documented, but evidence regarding pediatric AIS remains scarce. Our objective was to explore the predictors of hemorrhagic conversion among pediatric AIS patients on a nationwide level.
Methods
We queried the National Inpatient Sample(NIS) database from 2010 to 2019 for pediatric patients with a principal diagnosis of AIS using ICD-9/ICD-10-CM codes. Baseline demographics, comorbidities, and hospital complications were compared between treatment and non-treatment groups. Multivariable logistic regression models were used to evaluate risk factors and hemorrhagic transformation.
Results
From 2010 to 2019, we identified 7,365 hospitalizations attributed to pediatric strokes in patients aged 0–18 years old. Of these, 111(1.50%) were treated with EVT alone, 154(2.1%) with tPA alone, and 79(1.1%) received both EVT and tPA. The remainder 6997(95.3%) did not receive treatment. Children in the treatment groups had higher odds of hemorrhagic conversion compared to the no-treatment group: EVT alone (OR: 13.55; 95%CI:2.19–98.25, p=0.005), tPA alone (OR: 4.75; 95%CI:1.15–32.26, p = 0.005), and both treatments(OR: 7.55; 95% CI:1.16–49.31, p=0.035). Additionally, children with risk factors such as hypertension(OR: 5.25; 95%CI:2.13–10.22, p=0.025), hypercoagulability(OR: 3.48; 95%CI:1.44–10.34, p = 0.003), and cardiac conditions(OR: 6.71; 95%CI:1.15–21.32, p=0.035) were at higher risk of hemorrhagic conversion.
Conclusion
Our study highlights several risk factors associated with hemorrhagic transformation in pediatric AIS, including treatment modalities and underlying comorbidities. Early identification of these risk factors can aid in formulating preventive strategies and ultimately influence the incidence and management of pediatric stroke.