Stroke in Children Rare But Costly

By Ed Edelson
HealthDay Reporter

THURSDAY, July 9 (HealthDay News) -- Strokes in American youngsters under the age of 20 cost at least $42 million a year, a new study finds.

The incidence is not high -- between two and four per 100,000 young people annually, said Dr. Warren Lo, lead author of the report in the July 9 issue of Stroke, but there is growing concern about the cost of medical care in such cases.

"There is awareness that medical costs in this country are going up substantially, so we were curious about them in terms of stroke in young people," said Lo, an associate professor of pediatrics and neurology at Ohio State University and a pediatric neurologist at Nationwide Children's Hospital in Columbus, Ohio. "There are not many analyses out there because of a perception that this is a relatively uncommon disorder."

Lo and his collaborators did a detailed study of data on 2,224 strokes recorded for American children from infancy to age 20 in the national Kids' Inpatient Database for 2003. Some of their findings included:

• Strokes with subarachnoid hemorrhage, bleeding between the brain and the skull, required an average hospital stay of 11.2 days, at a cost of more than $31,000.
• Strokes with intracerebral hemorrhage, bleeding inside the brain, required an average hospital stay of 9.6 days, at a cost of more than $24,000.
• Ischemic strokes, blockage in a blood vessel in or leading to the brain, required an average hospital stay of 6.6 days, at a cost of $15,000.
• Of the total number of strokes, 22 percent were subarachnoid hemorrhages, 23 percent were intracerebral hemorrhages and 55 percent were ischemic.

"Ischemic strokes tend to be lower-cost," Lo said. "The bleeding types of stroke are more expensive."

A reason for doing the study is that "if we are able to identify what factors increase stroke risk, here is an argument for preventive measures not only because of the physical deficiencies they cause but also because of the cost to the country," Lo said.

The major risk factors for stroke in young people include sickle cell anemia and congenital heart disease, he said.

"We regularly see a child with stroke frequently associated with another diagnosis, such as sickle cell disease or congenital heart disease," said Dr. Jilda Vargus-Adams, an attending pediatric physiatrist who oversees rehabilitation services for such children at Cincinnati Children's Hospital Medical Center.

The prognosis for such children "varies widely because the impact of a stroke varies widely," Vargus-Adams said. "A child with a very severe stroke might spend weeks in the hospital, then weeks or in some cases months in a rehabilitation center. Almost all have an ongoing need for therapeutic care after discharge -- special equipment, perhaps."

One group of children not included in the new study are those who have strokes before birth, she said. "There is a huge subset of children who have strokes in utero and have a label of cerebral palsy," Vargus-Adams said. "Given what we know about cerebral palsy in general, we can say that the number of children with in utero stroke can approach or exceed the number who have strokes in childhood."

Those children who have strokes in childhood often respond well to therapy, she added. "They have the luxury of being able to go home, as opposed to going into a nursing home," Vargus-Adams said.

More information

Get information on pediatric stroke from American Stroke Association.