Incidence and Outcomes of Pediatric Patients with Developmental Disabilities Hospitalized for Acute Ischemic Stroke: A Retrospective Cross-sectional Analysis
Aarti Jain1, Nimrod Gozum1, Staton Albert1, Dorothy Liu1, Austin Li1, Eilene Basu2, Fawaz Al-Mufti3
1New York Medical College, 2M S Ramaiah Medical College and Hospital, 3Westchester Medical Center at New York Medical College
Objective:
The goal of the study is to evaluate the incidence and outcomes of stroke in pediatric patients with developmental disabilities.
Background:
Pediatric patients with developmental disabilities (DD) are less likely to receive intervention after acute ischemic stroke (AIS) and outcomes are devastating with increased rates of inpatient mortality in the hospital.
Design/Methods:
A retrospective cross-sectional analysis was conducted using data from the National Inpatient Sample (NIS) between 2015 and 2022 of pediatric patients (<18 years old) in the United States hospitalized for AIS with DD, including Down syndrome, cerebral palsy, and autism spectrum disorder.
Results:
Of 3,850 AIS hospitalizations in the pediatric population, 415 (10.8%) had DD. Of these patients, the majority were White (55.4%), male (51.8%), and on Medicaid (61.4%). Patients with DD were more likely to have sleep disorders and valvular disease and suffer complications of aspiration pneumonia and dysphagia (all p<0.05). Ninety-four percent of pediatric patients with DD did not receive IVT or EVT. Patients that did receive EVT had a decreased likelihood of routine discharge (OR: 0.02 [0.001-0.32], p=0.006). There were no differences in outcomes of routine discharge, inpatient mortality, or hemorrhagic transformation after IVT. Ultimately, pediatric patients with DD had a significantly decreased likelihood of routine discharge with equivalent likelihood of inpatient mortality.
Conclusions:
Of all pediatric patients who experienced stroke, over 10 percent had a developmental disability. The majority of the patients in this group did not receive any reperfusion therapy and were significantly less likely to experience routine discharge to home. There were no significant differences in post-IVT outcomes between the two groups. A significant barrier to early treatment of stroke in this population is delayed recognition of symptoms. In order to improve outcomes, future research on early identification of symptoms and intervention is needed.
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