Diagnosis Of Stroke In New Jersey Children On The Rise

NEW BRUNSWICK – Stroke is one of the top 10 causes of death among children according to the National Stroke Association. A new study published today shows that in New Jersey, the diagnosis of ischemic stroke in children, resulting from a loss or obstruction of blood to the brain, is on the rise. The research, published in Neurology®, the medical journal of the American Academy of Neurology, was conducted by researchers at the Cardiovascular Institute of New Jersey (CVI) at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

“This is the first statewide study that examines the incidence and long-term mortality from all types of stroke in New Jersey children from one month to 19 years of age,” said Sampada Gandhi, MBBS, MPH, instructor of medicine and primary author of the study. “The data report on an important trend for which little evidence exists, but which is imperative for physicians to understand to improve diagnosis and treatment in children with stroke.”

The researchers used the Myocardial Infarction Data Acquisition System (MIDAS) to examine the incidence of, and fatality from, ischemic stroke and hemorrhagic stroke (resulting from internal bleeding in the brain) in children from 1994 to 2007. MIDAS is a statewide database coordinated by CVI that tracks hospitalizations for myocardial infarction (heart attack), stroke, other vascular diseases, and deaths from 1986 to the present. The research also included a review of mortality rates at 30-days, one year and five years after initial stroke diagnosis.

The data show an initial decrease in the incidence of ischemic stroke in children from 1994 to 2001, but an increase in pediatric ischemic stroke thereafter. The study also shows that pediatric hemorrhagic stroke is twice as likely to be fatal when compared to ischemic stroke, but the incidence of hemorrhagic stroke remained stable throughout the 14-year study period.

“We believe that the initial decrease in ischemic stroke is the result of better stroke prevention in children at risk, particularly in children with sickle cell disease,” said James S. McKinney, MD, assistant professor of neurology at Robert Wood Johnson Medical School, and medical director of the Comprehensive Stroke Center at Robert Wood Johnson University Hospital, who contributed to the study. The subsequent increase in stroke in latter years is at least partially explained by “better awareness of stroke symptoms, improved diagnostic tools, including more accurate MRI testing, in children.”

According to the study, the data for New Jersey children are consistent with national trends and show that more than 17 percent of pediatric strokes were fatal within the first five years. The most prevalent reasons for pediatric ischemic stroke were the existence of hypertension, sickle cell disease and meningitis/encephalitis. Children who suffered from hemorrhagic stroke were more likely to have cardiac dysrhythmias and arteriovenous malformations (AVMs). The study also showed that approximately 75 percent of the children suffering from stroke died of non-cerebrovascular causes.

In addition to Dr. Gandhi and Dr. McKinney, contributors from Robert Wood Johnson Medical School include Nora M. Cosgrove, RN, head nurse; Jeanine E. Sedjro, MS, research teaching specialist; and John B. Kostis, MD, the John G. Detwiler Chair of Cardiology, professor of medicine, and founding director of The Cardiovascular Institute of New Jersey; and from Rutgers University, Javier Cabrera, PhD, professor and director, department of biostatistics. The study was supported by the Robert Wood Johnson Foundation and the Schering-Plough Foundation.

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