Pediatric neurology · 2026
Factors Associated With Intensive Care Unit Length of Stay After Acute Arterial Ischemic Stroke in Children.
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Dornoff Eric, Pagano Lindsay, Wolf Michael S, Horn Femke, Balamurugan Charu, Rodeghier Mark, Jordan Lori C
Аннотация
BACKGROUND: Identifying features of children with acute arterial ischemic stroke (AIS) who require only a short intensive care unit (ICU) stay to assure stability allows for optimal use of health care resources. We aimed to understand characteristics of children who received ≤1 night of ICU care after AIS.
METHODS: This retrospective observational, cross-sectional single-center study identified children (age 29 days-18 years) with AIS confirmed via neurology evaluation and neuroimaging, 2012-2024, from an institutional pediatric "code stroke" quality improvement database. Per institutional practice, most children with acute stroke are admitted to the ICU to assure stability.
RESULTS: Of 117 children with AIS, 33 (28%) were treated in the ICU for ≤1 night. The other 84 children required longer ICU stays, median 4.0 days (interquartile range: 2.0-8.0). Children with ≤1 ICU night were older, median age 14.0 vs 6.5 years, fewer had cardiac disease, 19% vs 46%, median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) was lower: 4 vs 9. Acute stroke interventions, N = 20, were not associated with shorter ICU stay nor was smaller stroke size. In multivariable logistic regression analysis, older age (odds ratio 1.14 95% confidence interval: 1.05-1.25; P = 0.003) and lower PedNIHSS (odds ratio: 0.87, 95% confidence interval 0.76-0.99; P = 0.031) were significantly associated with requiring ≤1 ICU night.
CONCLUSIONS: Among children with acute AIS, older age and lower PedNIHSS were associated with ≤1 ICU night. Identifying such children at the time of admission could result in a greater percentage of children with ≤1 ICU night, earlier intensive rehabilitation services, improved utilization of ICU beds, and cost-effective care.
METHODS: This retrospective observational, cross-sectional single-center study identified children (age 29 days-18 years) with AIS confirmed via neurology evaluation and neuroimaging, 2012-2024, from an institutional pediatric "code stroke" quality improvement database. Per institutional practice, most children with acute stroke are admitted to the ICU to assure stability.
RESULTS: Of 117 children with AIS, 33 (28%) were treated in the ICU for ≤1 night. The other 84 children required longer ICU stays, median 4.0 days (interquartile range: 2.0-8.0). Children with ≤1 ICU night were older, median age 14.0 vs 6.5 years, fewer had cardiac disease, 19% vs 46%, median Pediatric National Institutes of Health Stroke Scale (PedNIHSS) was lower: 4 vs 9. Acute stroke interventions, N = 20, were not associated with shorter ICU stay nor was smaller stroke size. In multivariable logistic regression analysis, older age (odds ratio 1.14 95% confidence interval: 1.05-1.25; P = 0.003) and lower PedNIHSS (odds ratio: 0.87, 95% confidence interval 0.76-0.99; P = 0.031) were significantly associated with requiring ≤1 ICU night.
CONCLUSIONS: Among children with acute AIS, older age and lower PedNIHSS were associated with ≤1 ICU night. Identifying such children at the time of admission could result in a greater percentage of children with ≤1 ICU night, earlier intensive rehabilitation services, improved utilization of ICU beds, and cost-effective care.