Factors Associated With Intensive Care Unit Length of Stay After Acute Arterial Ischemic Stroke in Children.

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.