Factors Associated with Pathway-Concordant Neuroimaging for Pediatric Ischemic Stroke

Abstract

ObjectiveTo determine factors associated with magnetic resonance imaging (MRI) and non-invasive diagnostic angiography among children presenting to the emergency department (ED) with acute ischemic stroke. Study DesignWe performed a cross-sectional study using data from >50 US children’s hospitals. We included children 29 days through 17 years old hospitalized from the ED with an International Classification of Disease, 10th revision, diagnosis code for acute ischemic stroke between October 1, 2015, and November 30, 2022. We excluded children with a principal diagnosis code of trauma/external injury, without neuroimaging on day of presentation, and into-ED transfers. Our outcomes were defined as acquisition of MRI (versus computed tomography only) and angiography (versus no angiography) on day of presentation. We performed generalized linear mixed modeling with hospital as a random effect to determine the association of demographics, known comorbidities, and treatment factors with each outcome. ResultsWe included 1,601 children. In multivariable analysis, younger age, mechanical ventilation, and Black race were associated with lower odds of MRI acquisition, while history of moyamoya disease and sickle cell disease were associated with higher odds. Younger age, mechanical ventilation, Hispanic ethnicity, Black race, other races, history of metabolic disease, and history of seizures were associated with lower odds of angiography. ConclusionsYounger and non-White children experienced lower odds of MRI and angiography, which may be driven by health system limitations or provider implicit biases or both. Our results expose risk factors for underdiagnosis of ischemic stroke and provide opportunities to tailor institutional pathways reflective of underlying pathophysiology.