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International Journal of Stroke 18(5)
Figure 3. Distribution of baseline clinical characteristics between patients treated with intravenous thrombolysis (IVT) and
other medical management (OMM) following propensity-score adjustment. For all comparisons, p > 0.05.
treatment modality, without utilization of randomization
and prospective evaluation, as well as a lack of important
baseline clinical characteristics. Prognostically significant
data absent from this analysis include comprehensive neurological
exam details, baseline National Institutes of
Health Stroke Scale score, radiographic findings, and time
of last known well and initiation of treatment. In addition,
as mentioned previously, it is unclear how a determination
of any ICH was made by use of ICD billing codes alone,
and ECASS classification of ICH severity was not available.
Although validated data are presented to justify the
selection of discharge dispositions for the definition of
favorable functional outcome, these analyses were performed
in adult stroke cohorts, which calls into question the
extension and applicability of this same definition to the
pediatric stroke population. More highly disabled patients
(with modified Rankin score (mRS) scores of 3, for example)
may have been included in the definition of favorable
outcome in this analysis. Despite these limitations, this
study presents the largest and most comprehensive evaluation
of IVT in pediatric stroke to data and the use of a largescale
national registry enhances the generalizability of our
findings.
Conclusion
Our population-level analysis demonstrates a favorable
efficacy and safety profile of IVT in pediatric acute
ischemic stroke. Children and adolescents fare remarkably
well after treatment with IVT in comparison with both
older adult patients and those of pediatric patients from
older large-scale studies. In the absence of conclusive data
International Journal of Stroke, 18(5)
from randomized clinical trials, this study provides unique
and valuable clinical insight.
Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication
of this article: E.C.M. is supported by the National Institutes of
Health National Institute of Neurological Disorders and Stroke
(K23NS107645, L30NS103295, R01NS122815), the National
Institutes of Health National Institute on Aging (R21AG069111),
and the Gerstner Family Foundation (Gerstner Scholars
Program). Other authors disclose no conflicts of interest or
funding.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iDs
Alis J Dicpinigaitis
Eliza C Miller
Shadi Yaghi
https://orcid.org/0000-0001-8625-4949
https://orcid.org/0000-0002-7108-8906
https://orcid.org/0000-0003-0031-1004
References
1. Campbell BCV, De Silva DA, Macleod MR, Coutts SB,
Schwamm LH, Davis SM and Donnan GA. Ischaemic stroke.
Nat Rev Dis Primers 2019; 5: 70.
2. Rivkin MJ, deVeber G, Ichord RN, et al. Thrombolysis in
pediatric stroke study. Stroke 2015; 46: 880-885.
3. Lehman LL, Khoury JC, Taylor JM, et al. Pediatric stroke
rates over 17 years: report from a population-based study. J
Child Neurol 2018; 33: 463-467.

https://www.orcid.org/0000-0001-8625-4949 https://www.orcid.org/0000-0002-7108-8906 https://www.orcid.org/0000-0003-0031-1004

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