Clinical Profile and Outcomes of Children With Cerebral Vascular Disease at Kenyatta National Hospital

Abstract

Background: Cerebral Vascular Diseases (CVDs) in childhood are an important cause of morbidity and mortality. They also have a significant financial impact on the families of the survivors. Most population based studies on childhood CVDs have been conducted in Europe and North America. However, little is known about cerebral vascular diseases in Sub-Saharan African children yet the risk factors, genetic predisposition and environmental context differs widely limiting replicability. Objectives: The study aimed to describe the clinical profile of children aged 1 month to 18 years with cerebral vascular disease, their outcomes and to correlate the clinical outcomes with the major types of CVDs. Methodology: This was a retrospective cohort study carried out at Kenyatta National Hospital (KNH) among children aged one month to eighteen years diagnosed with CVDs between October 2013 and April 2016. Data was collected from the health records department by reviewing patient files. This included the demographic data (age, sex), initial presentation, risk factors and outcome. Outcomes of interest included length of hospital stay, time from admission to diagnosis, presence of recurrent stroke, presence of residual impairment and mortality. Categorical data was summarized into percentages while continuous variables analysed and presented as means or medians where applicable. Type and cause of cerebral vascular disease was associated with clinical outcomes using Chi square test of associations for categorical outcomes and Student’s t test for comparison of means for the continuous outcomes. Statistical tests were interpreted at 5% level of significance (p value less or equal to 0.05) and findings presented in form of tables, graphs and charts. Results: A list of 145 files was identified. Eighty five (85) were included in the study. The median age was six (6) years (IQR 3.1-10.0) with a male: female ratio of 1.24:1. There were 47 (55.3%) males and 38 (44.7%) females. The most common clinical presentations included seizures (37; 43.5%), weakness (35; 41.2%), headaches (18; 21.2%) and altered consciousness (18; 21.2%). Sickle cell disease and intracranial infections were identified as the main risk factors at 22 (25.9%) and 20 (23.5%) respectively. Ischaemic stroke was the most commonly identified type of cerebral vascular disease (CVD) (57; 67%) followed by haemorrhagic stroke (21; 25%). Subarachnoid haemorrhage and cerebral venous sinus thrombosis were the least common types of CVD; 6(7%) and 1 (1%) respectively. The clinical outcomes of children with CVDs were as follows: mean length of hospital stay was 15 days and median duration from admission to diagnosis was 2 days (interquartile range 0-6.5).Fifteen (15) of the total 85 died (17.6%). Of those who were alive (70; 82.4%), 6 (8.6%) had recurrent stroke and 56 (80%) had residual impairment. Majority had weakness as a residual impairment (25; 44.6%). Conclusion: Ischemic stroke was the most common type of cerebral vascular disease with Sickle Cell Disease and intracranial infections identified and the major risk factors. Many of the patients had multiple clinical presentations but seizures and weakness were the most common. In those with residual impairment, weakness was the most prevalent. There was 17.6% mortality.