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National trends in incidence rates of hospitalization for stroke in children with sickle cell disease

Authors

  • Timothy L. McCavit MD,

    Corresponding author
    1. Division of Pediatric Hematology–Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
    2. Children's Medical Center Dallas, Dallas, Texas
    • University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063.
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  • Lei Xuan PhD,

    1. Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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  • Song Zhang PhD,

    1. Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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  • Glenn Flores MD,

    1. Children's Medical Center Dallas, Dallas, Texas
    2. Department of Clinical Sciences, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
    3. Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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  • Charles T. Quinn MD, MS

    1. Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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  • Conflict of interest: Nothing to declare.

  • Prior presentations: This work was presented in part at the American Society of Pediatric Hematology–Oncology Annual Meeting, Montreal, Quebec, CA, April 9, 2010.

Abstract

Background

The success of primary stroke prevention for children with sickle cell disease (SCD) throughout the United States is unknown. Therefore, we aimed to generate national incidence rates of hospitalization for stroke in children with sickle cell disease (SCD) before and after publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998.

Procedure

We performed a retrospective trend analysis of the 1993–2009 Nationwide Inpatient Sample and Kids' Inpatient Databases. Hospitalizations for SCD patients 0–18 years old with stroke were identified by ICD-9CM code. The primary outcome, the trend in annual incidence rate of hospitalization for stroke in children with SCD, was analyzed by linear regression. Incidence rates of hospitalization for stroke before and after 1998 were compared by the Wilcoxon rank-sum test.

Results

From 1993 to 2009, 2,024 hospitalizations were identified for stroke. Using the mean annual incidence rate of hospitalization for stroke from 1993 to 1998 as the baseline, the rate decreased from 1993 to 2009 (point estimate = −0.022/100 patient years [95% CI, −0.039, −0.005], P = 0.027). The mean annual incidence rate of hospitalization stroke decreased by 45% from 0.51 per 100 patient years in 1993–1998 to 0.28 per 100 patient years in 1999–2009 (P = 0.008). Total hospital days and charges attributed to stroke also decreased by 45% and 24%, respectively.

Conclusions

After publication of the STOP trial and hydroxyurea licensure in 1998, the incidence of hospitalization for stroke in children with SCD decreased across the United States, suggesting that primary stroke prevention has been effective nationwide, but opportunity for improvement remains. Pediatr Blood Cancer 2013; 60: 823–827. © 2012 Wiley Periodicals, Inc.

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