Association Between Infarct Volume, Neighborhood-Level Deprivation, and Outcomes In Pediatric Stroke

Introduction Recent studies in adults have reported an association between neighborhood-level deprivation, infarct volume and outcome. However, this is yet to be investigated in pediatric arterial ischemic stroke (AIS). We assessed the relationship between neighborhood deprivation, infarct volume, and outcome for pediatric AIS patients.

Methods We conducted a study of a consecutive cohort of children aged >28 days - 18 years and diagnosed with AIS between 2004 and 2019 at a comprehensive stroke center. Material deprivation data included household income, parental education, proportion of single-parent families, and housing quality. Lesion volumes were determined by conducting semi-automatic segmentation of diffusion-weighted MRI brain scans at presentation. Poor outcome was defined as moderate-to-severe deficit at 18 months post-stroke.

Results Seventy-two patients were included in the study (62% male, median age of stroke onset 6.1 years [IQR 1.0-12.7]). Cardiac disease and other risk factors including infection and head trauma were the most common in our cohort. Median lesion volume was 14 cm3 (IQR 2-51) and mean infarct volume was 3%. Percent infarct volume was significantly associated with 18 months post-stroke outcome (W = 79, p = 0.025).

Conclusion We confirmed the relationship between infarct volume and pediatric AIS outcomes. Future studies are warranted to further understand the interplay between material deprivation, infarct volume, and pediatric AIS outcomes.