Abstract T P323: National Trends in Utilization and Outcomes of Intravenous Thrombolytic Treatment Among Pediatric Patients With Acute Ischemic Stroke in United States

Background: Thrombolytic treatment has been used with varying frequency among pediatric ischemic stroke patients. Objective: To evaluate trends in utilization of IV recombinant tissue plasminogen activator (rt-PA) and associated rates of death and disability among acute ischemic stroke patients over a six year period. Methods: We obtained data for pediatric patients (aged ≤18 years) admitted to United States in 2003, 2006 and 2009 with a primary diagnosis of ischemic stroke using the Nationwide Inpatient Sample (NIS-KID). We determined the rate and pattern of utilization, and associated in-hospital outcomes of IV-rt-PA including post-thrombolytic intracerebral hemorrhage (ICH) and rates death among pediatric ischemic stroke patients. Results: Of the 5,137 pediatric patients admitted with ischemic stroke, 48 (0.93%) received IV rt-PA during the study period. There was a 2.5 fold increase in rates of patients who received the thrombolytic treatment (0.53% in 2003, 0.87% in 2006 and 1.35% in 2009). The rate of post-thrombolytic ICH was 9.6% with no change in frequency over the three periods. The overall rate of post-thrombolytic intracerebral hemorrhage (ICH) was 9.6% with a trend towards decrease in rates (41%, 9.8%, and 0%) in 2003, 2006, and 2009. The overall rate of in hospital mortality was 9.6% with some decrease in rates (17.2%, 13.0%, and 5.9%, p value for trend=0.7). Conclusion: There has been a significant increase in the proportion of pediatric acute ischemic stroke patients receiving IV rt-PA treatment with some evidence of decrease in adverse outcomes at discharge.

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