WSO - April 2023 - 469

1127538
WSO
International Journal of StrokeKaur et al.
Research
Age-specific trends in intravenous
thrombolysis and mechanical
thrombectomy utilization in acute
ischemic stroke in children under age 18
Navreet Kaur1, Smit Patel2 , Michael Omoniyi Ayanbadejo3,
Haydn Hoffman4, Emmanuel Akano5, Nnabuchi Anikpezie6
Ehimen Aneni7 , Oluwatomi Lamikanra8, Claribel Wee1,
Karen Albright1, Priyank Khandelwal9, Julius Gene Latorre1,
Seemant Chaturvedi10 and Fadar Oliver Otite1
,
International Journal of Stroke
2023, Vol. 18(4) 469 -476
© 2022 World Stroke Organization
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DOI: 10.1177/17474930221127538
journals.sagepub.com/home/wso
https://doi.org/10.1177/17474930221127538
Abstract
Objectives: To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy
(MT) in acute ischemic stroke (AIS) in various age groups of children in the United States.
Methods: We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted
n = 2807) contained in the 2009-2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were
calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment.
Results: From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys
and 29.9% were 15-17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5-9 years: 3.1%, 15-
17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1-4 years: 0.9% and 15-17years
4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value =
0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA
utilization was seen primarily in children 10-14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15-17 years
(5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time.
MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in
nonchildren's hospitals (both p values < 0.05) but usage in designated children's hospitals did not change significantly
over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or
insurance status.
Conclusion: IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in
older children 10-17 years. Utilization increased mainly in patients hospitalized in nonchildren's hospitals. Usage in children's
hospitals did not change significantly over time.
1Department of Neurology, SUNY Upstate Medical University, Syracuse, NY, USA
2Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
3Neuroscience Service line, Mercy Hospital, Buffalo, NY, USA
4Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
5Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
6Department of Population Health, University of Mississippi, Jackson, MS, USA
7Department of Cardiology, Yale University, New Haven, CT, USA
8Department of Critical Care, Springfield Clinic, Springfield, IL, USA
9Departments of Neurology and Neurosurgery, Rutgers University New Jersey, Newark, NJ, USA
10Department of Neurology, University of Maryland, Baltimore, MD, USA
Corresponding author:
Fadar Oliver Otite, Department of Neurology, SUNY Upstate Medical University, 750 East Adams St, Syracuse, NY 13210, USA.
Email: otitef@upstate.edu
Twitter handles: @oliverotite
International Journal of Stroke, 18(4)
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