The incidence of pediatric ischemic stroke: A systematic review and meta-analysis

Abstract

Background: Despite its importance in being amongst the top ten causes of childhood death, there is limited data on the incidence of stroke in children, and whether this has changed over time. Aims: We performed a systematic review and meta-analysis to estimate the worldwide incidence rate of paediatric ischaemic stroke, identify population differences, and trends in incidence. Methods: We screened three databases (Medline, Embase and CINAHL) and a Google Search to October 2021. The protocol was pre-registered :PROSPERO: CRD42021273749). Data extraction and quality assessment was independently undertaken by two reviewers. A random-effects model was used for meta-analysis using Stata SE17 to calculate the overall incidence rate. Heterogeneity was assessed using I2. Meta-regression and assessment for bias were performed. Results: Out of 4,166 records identified, 39 studies were included in the qualitative synthesis and the quantitative meta-analysis. The pooled incidence rate for all ischaemic strokes was varied from 0.9 to 7.9 per 100,000 person-years, with a pooled incidence of 2.09 (95% CI: 1.57–2.76). The pooled incidence was 1.28 (95% CI: 0.75 – 2.19) per 100,000 person-years for arterial ischaemic stroke, and 0.56 (95% CI: 0.31 – 1.02) per 100,000 person-years for cerebral venous sinus thrombosis. The incidence of arterial ischaemic stroke was high in neonates, less than 28 days old (18.51 (95% CI 12.70–26.97). There was significant heterogeneity observed in the stroke incidence estimates initial analyses but geographical region, cohort age upper limit, length of study, study quality, and study design could not explain this. The incidence rate of childhood stroke appeared remained relatively stable over time. Conclusion: Our review provides estimates of global stroke incidence, including stroke subtypes, in children. It demonstrates a particularly high stroke incidence in neonates.

Functional symptoms in children may be much more common than previously believed

“…This suggests that pediatric FND is 21-fold more common than pediatric multiple sclerosis, 3 and 8.8-fold more common than pediatric stroke. 4 FND symptoms were more persistent than in prior studies, with 79% having ongoing symptoms at last follow-up. Several factors impact the accuracy of incidence measures.…”

“…They found that FND is substantially more common than previously measured (incidence of 18.3/100 000). This suggests that pediatric FND is 21‐fold more common than pediatric multiple sclerosis, 3 and 8.8‐fold more common than pediatric stroke 4 . FND symptoms were more persistent than in prior studies, with 79% having ongoing symptoms at last follow‐up.…”

Epidemiology, causes, and morbidities of stroke in the young

“…Seizures were the most common clinical presentation occurring in 36 of 55 neonates. A 2023 systematic review and meta-analysis reported the global incidence of perinatal ischemic stroke at 38.6 per 100 000 live-births (two studies), with AIS incidence of 18.5 per 100 000 live-births (nine studies) and venous ischemic stroke of 5.56 per 100 000 live-births (three studies) [3 ▪ ].…”

Stroke subtypes and outcomes in China, common clinical conundrums in stroke management, and pediatric stroke

“…This is rare compared with adult stroke, 15 but is one of the most common causes of severe neurological injury in the young, and among the top 10 causes of childhood death. 16 However, there are limited data on the incidence of stroke in children and whether this has changed over time. In this issue, Gao et al 16 address this with a comprehensive systemic review and meta-analysis.…”

“…16 However, there are limited data on the incidence of stroke in children and whether this has changed over time. In this issue, Gao et al 16 address this with a comprehensive systemic review and meta-analysis. They include data from 39 studies, of which 13 were from North America, 21 from Europe, and 5 from the pan-Pacific region (2 from Oceania and 3 from Asia).…”