Incidence, characteristics, and outcomes of pediatric patients with sickle cell disease and acute ischemic stroke.

BACKGROUND: There are significant risk factors and consequences of acute ischemic stroke (AIS) in pediatric sickle cell disease (SCD) patients, and currently no studies have analyzed the associations between SCD and pediatric AIS in a large, highly powered cohort. METHODS: Querying the National Inpatient Sample (NIS) database from 2016 to 2019, we identified patients with a primary diagnosis of AIS using the International Classification of Diseases, 10th Edition (ICD-10) codes. We compared pediatric patients without SCD (AIS-non-SCD) to those with SCD (AIS-SCD) across various parameters, including demographic characteristics, comorbidities, acute stroke indices, inpatient complications, and treatments. Primary outcomes analyzed included length of stay (LOS), discharge disposition, and inpatient mortality. RESULTS: Among 12,755 pediatric AIS patients, 495 (3.9%) had SCD. Pediatric AIS-SCD patients were more likely to have hypertension (OR 2.73, p < 0.01), be on long-term anticoagulation/antiplatelet therapy (OR 2.35, p < 0.01), and long-term drug therapy (OR 3.88, p < 0.01). They were less likely to have cerebral edema, herniation, coma, or require mechanical ventilation (all p < 0.01). AIS-SCD patients had lower rates of complications such as acute kidney injury, sepsis, and percutaneous endoscopic gastrostomy (all p < 0.01). In a matched cohort, AIS-SCD patients had shorter LOS (OR -13.96, p < 0.01), higher likelihood of discharge to home (OR 1.79, p = 0.04), and lower inpatient mortality (OR 0.23, p = 0.01). CONCLUSIONS: Pediatric AIS-SCD patients demonstrated lower complication rates and superior outcomes, despite discharge placement to acute rehabilitation and long-term care facilities. Enhanced awareness and timely presentation could potentially increase AIS diagnosis rates in the pediatric population with sickle cell disease.

Duke Scholars

Author Carrie Rebecca Muh Neurosurgery