Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18

Navreet Kaur; Smit Patel; Michael Omoniyi Ayanbadejo; Haydn Hoffman; Emmanuel Akano; Nnabuchi Anikpezie; Ehimen Aneni; Oluwatomi Lamikanra; Claribel Wee; Karen Albright; Priyank Khandelwal; Julius Gene Latorre; Seemant Chaturvedi; Fadar Oliver Otite

doi:10.1177/17474930221127538

journal article Oct 15, 2022

Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18

Navreet Kaur Smit Patel

Michael Omoniyi Ayanbadejo Haydn Hoffman

Emmanuel Akano Nnabuchi Anikpezie

Ehimen Aneni

Oluwatomi Lamikanra Claribel Wee Karen Albright Priyank Khandelwal Julius Gene Latorre Seemant Chaturvedi Fadar Oliver Otite

International Journal of Stroke Vol. 18 No. 4 pp. 469-476 · SAGE Publications

View at Publisher Save 10.1177/17474930221127538

Abstract

Objectives: To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States. Methods: We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009–2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment. Results: From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15–17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5–9 years: 3.1%, 15–17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1–4 years: 0.9% and 15–17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value = 0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10–14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15–17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren’s hospitals (both p values < 0.05) but usage in designated children’s hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status. Conclusion: IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10–17 years. Utilization increased mainly in patients hospitalized in nonchildren’s hospitals. Usage in children’s hospitals did not change significantly over time.

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Details

Published: Oct 15, 2022
Vol/Issue: 18(4)
Pages: 469-476
License: View

Authors

N

Navreet Kaur

Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA

S

Smit Patel

Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA

M

Michael Omoniyi Ayanbadejo

Neuroscience Service line, Mercy Hospital, Buffalo, NY, USA

H

Haydn Hoffman

Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA

E

Emmanuel Akano

Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

N

Nnabuchi Anikpezie

Department of Population Health, University of Mississippi, Jackson, MS, USA

E

Ehimen Aneni

Department of Cardiology, Yale University, New Haven, CT, USA

O

Oluwatomi Lamikanra

Department of Critical Care, Springfield Clinic, Springfield, IL, USA

C

Claribel Wee

Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA

K

Karen Albright

Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA

P

Priyank Khandelwal

Departments of Neurology and Neurosurgery, Rutgers University New Jersey, Newark, NJ, USA

J

Julius Gene Latorre

Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA

S

Seemant Chaturvedi

Department of Neurology, University of Maryland, Baltimore, MD, USA

F

Fadar Oliver Otite

Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA

Cite This Article

Navreet Kaur, Smit Patel, Michael Omoniyi Ayanbadejo, et al. (2022). Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18. International Journal of Stroke, 18(4), 469-476. https://doi.org/10.1177/17474930221127538

Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18

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