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Imaging data reveal a higher pediatric stroke incidence than prior US estimates.

ABSTRACT: Prior annualized estimates of pediatric ischemic stroke incidence have ranged from 0.54 to 1.2 per 100,000 US children but relied purely on diagnostic code searches to identify cases. We sought to obtain a new estimate using both diagnostic code searches and searches of radiology reports and to assess the relative value of these 2 strategies.Using the population of 2.3 million children (<20 years old) enrolled in a Northern Californian managed care plan (1993 to 2003), we performed electronic searches of (1) inpatient and outpatient diagnoses for International Classification of Diseases, 9th Revision codes suggestive of stroke and cerebral palsy; and (2) radiology reports for key words suggestive of infarction. Cases were confirmed through chart review. We calculated sensitivities and positive predictive values for the 2 search strategies.We identified 1307 potential cases from the International Classification of Diseases, 9th Revision code search and 510 from the radiology search. A total of 205 ischemic stroke cases were confirmed, yielding an ischemic stroke incidence of 2.4 per 100,000 person-years. The radiology search had a higher sensitivity (83%) than the International Classification of Diseases, 9th Revision code search (39%), although both had low positive predictive values. For perinatal stroke, the sensitivity of the stroke International Classification of Diseases, 9th Revision codes alone was 12% versus 57% for stroke and cerebral palsy codes combined; the radiology search was again the most sensitive (87%).Our incidence estimate doubles that of prior US reports, a difference at least partially explained by our use of radiology searches for case identification. Studies relying purely on International Classification of Diseases, 9th Revision code searches may underestimate childhood ischemic stroke rates, particularly for neonates.

SUBMITTER: Agrawal N

PROVIDER: S-EPMC3387270 | biostudies-literature | 2009 Nov

REPOSITORIES: biostudies-literature

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Imaging data reveal a higher pediatric stroke incidence than prior US estimates.

Agrawal Nidhi N Johnston S Claiborne SC Wu Yvonne W YW Sidney Stephen S Fullerton Heather J HJ

Stroke 20090917 11

<h4>Background and purpose</h4>Prior annualized estimates of pediatric ischemic stroke incidence have ranged from 0.54 to 1.2 per 100,000 US children but relied purely on diagnostic code searches to identify cases. We sought to obtain a new estimate using both diagnostic code searches and searches of radiology reports and to assess the relative value of these 2 strategies.<h4>Methods</h4>Using the population of 2.3 million children (<20 years old) enrolled in a Northern Californian managed care ...[more]

PMID: 19762687

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Project description:Limited information exists about the incidence of first-ever stroke at the population level, particularly in low- and middle-income countries (LMIC). Longitudinal data from the CRONICAS Cohort Study includes both altitude and urbanization and allows a detailed assessment of stroke incidence in resource constrained settings. The aim of this study was to estimate the incidence and explore risk factors of first-ever stroke at the population level in Peru. Stroke was defined using a standardised approach based on information from cohort participants or family members. This information was adjudicated centrally by trained physicians using common definitions. Time of follow-up was calculated as the difference between date of enrolment and the reported date of the stroke event. Unstandardised and age-standardised, first-ever stroke incidence rate and 95% confidence intervals (95% CI) were calculated. Generalized linear models, assuming Poisson distribution and link log, were utilized to determine potential factors to develop stroke. 3,601 individuals were originally enrolled in the cohort and 2,471 provided data for the longitudinal analysis. The median time of follow-up was 7.0 (range: 1 - 9) years, accruing a total of 17,308 person-years. During followup, there were 25 incident cases of stroke, resulting in an age-standardised incidence of stroke of 98.8 (95% CI: 63.8 - 154.0) per 100,000 person-years. After adjustment by age and sex, stroke incidence was higher among people with hypertension (incidence risk ratio (IRR) = 5.18; 95% CI: 1.89 - 14.16), but lower among people living at high altitude (IRR = 0.09; 95% CI: 0.01 - 0.63). Our results indicate a high incidence of first-ever strokes in Peruvian general population. These results are consistent with the estimates found in previous LMIC reports. Our study also found a contributing role of hypertension, increasing the risk of having a first-ever stroke. This work further advances the field of stroke epidemiology by identifying high altitude as a factor related to lower incidence of stroke in a longitudinal study. However, this information needs to be considered with cautions because of the study limitations.

Project description:Background and purposeTo assess whether initial imaging characteristics independently predict 1-year neurological outcomes in childhood arterial ischemic stroke patients.MethodsWe used prospectively collected demographic and clinical data, imaging data, and 1-year outcomes from the VIPS study (Vascular Effects of Infection in Pediatric Stroke). In 288 patients with first-time stroke, we measured infarct volume and location on the acute magnetic resonance imaging studies and hemorrhagic transformation on brain imaging studies during the acute presentation. Neurological outcome was assessed with the Pediatric Stroke Outcome Measure. We used univariate and multivariable ordinal logistic regression models to test the association between imaging characteristics and outcome.ResultsUnivariate analysis demonstrated that infarcts involving uncinate fasciculus, angular gyrus, insular cortex, or that extended from cortex to the subcortical nuclei were significantly associated with poorer outcomes with odds ratios ranging from 1.95 to 3.95. All locations except the insular cortex remained significant predictors of poor outcome on multivariable analysis. When infarct volume was added to the model, the locations did not remain significant. Larger infarct volumes and younger age at stroke onset were significantly associated with poorer outcome, but the strength of the relationships was weak. Hemorrhagic transformation did not predict outcome.ConclusionsIn the largest pediatric arterial ischemic stroke cohort collected to date, we showed that larger infarct volume and younger age at stroke were associated with poorer outcomes. We made the novel observation that the strength of these associations was modest and limits the ability to use these characteristics to predict outcome in children. Infarcts affecting specific locations were significantly associated with poorer outcomes in univariate and multivariable analyses but lost significance when adjusted for infarct volume. Our findings suggest that infarcts that disrupt critical networks have a disproportionate impact upon outcome after childhood arterial ischemic stroke.

Project description:IntroductionThe incidence and prevalence of diabetes within a population are important public health metrics. Pharmaceutical administrative data may offer a resource that can contribute to quantifying these measures using the recorded signals derived from the drugs used to treat people with diabetes.ObjectiveTo estimate the longitudinal incidence and prevalence of drug treated (DT) diabetes in Australia utilising an Australian Pharmaceutical Benefits Scheme (PBS) dataset and compare estimates with community survey data for all diabetes reported in the Australian National Health Survey (NHS).MethodsPersons with DT diabetes were identified within the PBS dataset using assigned Anatomic Therapeutic Chemical codes for 'Drugs used in diabetes'. Prevalent persons with DT diabetes were determined by a single annual treatment, and incident cases from the earliest treatment with diabetes medications. Counts were aggregated by age group and utilised Australian national census data as a denominator to calculate diabetes disease frequencies for the period 2004-14. Comparison of PBS prevalence data was made with NHS surveys over equivalent years.ResultsThe age adjusted incidence of DT diabetes was 3.4/1000 in 2006 and increased to 3.8/1000 in 2011 and 5.1/1000 in 2014. Age adjusted prevalence of DT diabetes in Australia also rose from 26.7/1000 in 2006 to 32.1/1000 in 2011 and 42.1/1000 in 2014. DT diabetes prevalence estimates correlated with NHS estimates of self-reported diabetes prevalence across age groups and in 2014 was r = 0.987. However, PBS estimates of DT diabetes prevalence generally underestimated NHS values of self-reported diabetes in older age groups with mean percentage differences of -22% to -3%. In contrast, PBS data captured more younger persons with diabetes in comparison to NHS data. These differences were then used to adjust DT diabetes incidence rates to provide age specific estimates that could potentially reflect diabetes incidence estimates acquired by community survey.ConclusionsPBS data representing dispensed medications prescribed to persons with diabetes offers a perspective for the assessment of diabetes incidence and prevalence. PBS derived DT diabetes prevalence estimates correlate well with community survey estimates of self-reported diabetes, but underestimate NHS data in older age groups. Calibrated DT incidence estimates may potentially reflect community survey derived diabetes incidence estimates and may offer a method for longitudinal monitoring.

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Imaging data reveal a higher pediatric stroke incidence than prior US estimates.

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Imaging data reveal a higher pediatric stroke incidence than prior US estimates.

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