Transient ischemic attack requiring hospitalization of children in the United States: kids' inpatient database 2003 to 2009

Abstract

Background and purpose: Transient ischemic attacks (TIA) are not well described in children. We assessed the prevalence of risk factors for TIA requiring hospitalization in children in a large national database.

Methods: Using the Healthcare Cost and Utilization Project Kids' Inpatient Database, children aged 1 to 18 years admitted for TIA in 2003, 2006, and 2009 were identified by International Classification of Diseases, Ninth Revision, Clinical Modification code 435. Descriptive analyses identified patient characteristics. Trend analysis determined the change in annual average hospitalization days from 2003 to 2009.

Results: TIA was the primary diagnosis for 531 children. Important secondary diagnoses included sickle cell disease (20%), congenital heart disease (11%), migraine (12%), moyamoya disease (10%), and stroke (4%). Mean length of stay decreased from 3.0 days (95% confidence interval, 2.4-3.6) in 2003 to 2.3 days (95% confidence interval, 2.0-2.7) in 2009 (P=0.04). During the same period, 2590 children were admitted with ischemic stroke; 4.8 children with stroke were admitted for every child with TIA.

Conclusions: Recognized risk factors for TIA, including sickle cell disease, congenital heart disease, moyamoya, recent stroke, and migraine, were present in <60% of children. Pediatric admissions for ischemic stroke were ≈5-fold more common than for TIA. Further study is required to understand the risk of stroke after TIA in children to guide appropriate evaluation and treatment.

Keywords: child; ischemic attack, transient; stroke.