Abstract T P362: Blood Pressure, Blood Glucose, Temperature and Outcome after Childhood Stroke

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Objective: To determine the prevalence of abnormal blood pressure (BP), blood glucose and temperature in the acute phase after ischemic stroke (IS) and explore any relationship to outcome. We hypothesized that high and low BP, hyperglycemia, and fever after pediatric IS were all associated with poor outcome. Methods: We performed a retrospective review of children aged 1 month to 18 years with first IS admitted to a tertiary hospital between 2009 and 2013. Blood pressure, glucose and temperature readings recorded over the first 5 days after diagnosis. Morbidity or mortality and BP at 3 months post-stroke were documented. Hypertension (HTN) was defined as systolic or diastolic BP ≥95th% percentile for age, sex, and height for two consecutive recordings and two consecutive days. Results: Ninety-eight children were identified (median age 6 years). Prevalence of hypertension, hypotension, hyperglycemia and fever was 65%, 68%, 18%, and 41%, respectively. In multivariable analysis, the strongest association with poor outcome (defined as pediatric stroke outcome measure ≥1) was infarct size >4% of brain volume [odds ratio (OR) 5.3, CI 1.8-15.3, p=0.002]. Blood glucose ≥200mg/dL was also independently associated with poor outcome (OR 4.6, CI 1.3-16.3, p=0.015). Hypotension requiring treatment (p=0.02, Fisher Exact Test) and fever ≥37.8°C (p=0.03, X2=4.6) were associated with poor outcome in univariable testing only. Hypertension was not significantly associated with stroke size, poor outcome, or death. During the acute post-stroke period 18% were treated with anti-hypertensive medication. At 3-months post-stroke, 11 children had died; 90% of the survivors followed up. Of these, 15 of 78 (19%) were receiving anti-hypertensive medication, an additional 9 children were hypertensive but untreated. Conclusions: Abnormalities of BP, blood glucose and temperature are prevalent in children with IS during the first 5 days after diagnosis. Infarct size and hyperglycemia were associated with poor outcome, hypertension was not. Prospective studies involving systematic recording of BP, blood glucose and temperature are required to better assess whether these factors impact outcome and are amenable to intervention to reduce morbidity after stroke in children.