Temporal trends in incidence and long-term case fatality of stroke among children from 1994 to 2007

Objective: To examine the trends in incidence and long-term case fatality of childhood stroke in New Jersey using a statewide administrative database for the years 1994–2007. Methods: We assessed demographic and clinical information for children with stroke using the Myocardial Infarction Data Acquisition System (MIDAS) database. We ascertained deaths by matching MIDAS records to New Jersey Death Registration Files at 30 days, 1 year, and 5 years from the index stroke. Results: During the 14-year study period, 715 children were hospitalized for a first time with stroke. Age-adjusted incidence of stroke demonstrated a significant quadratic trend in which the rates decreased from 1994 to a nadir at 1999–2001 and increased thereafter (overall p for trend = 0.06 with quadratic term p = 0.02). Better treatment of sickle cell disease with transfusion therapy after year 1998 ( p = 0.007) and improved diagnostic accuracy of MRI ( p = 0.009) may partially explain these trends. Thirty-day, 1-year, and 5-year case fatality rates were 12.3%, 15.7%, and 17.5%, respectively. At all time periods, adjusted survival from hemorrhagic stroke was significantly lower than that from ischemic stroke ( p = 0.0005). Conclusions: After an initial decrease, the incidence of pediatric stroke is rising. Children with hemorrhagic stroke had a 2 times higher risk of death than those with ischemic stroke. Whereas approximately 70% of all deaths occurred within the first month of hospitalization, an additional 5.2% of the initial study cohort died over the next 5 years.