Seby John, MD

Adil MM, Qureshi AI, Beslow LA, and Jordan LC. Transient Ischemic Attack Requiring Hospitalization of Children in the United States: Kids’ Inpatient Database 2003 to 2009. Stroke. 2014

What if a child presents to you with a TIA.  Do you have an ABCD like risk stratification score you can use? Do you observe, admit or discharge the patient? What risk factors do you evaluate for?  If your patient was an adult, you would readily have answers for most of these questions. Unfortunately, they do not apply to children. The recent years have seen more focus on pediatric ischemic stroke, but there is sparse data on TIA.

In this paper, Adil and colleagues attempt to understand the prevalence and risk factors associated with TIA. They used the national Kid’s Inpatient Database to identify children aged 1-18 years who were admitted with a diagnosis of TIA in 2003, 2006 and 2009. ICD-9 codes were used to identify these admissions, and record other secondary diagnoses. During this time, 531 children were admitted with TIA with two-thirds being adolescents aged 11-18. Important secondary diagnosis included sickle cell disease, congenital heart disease, moyamoya, recent stroke and migraine. Close to 40% had no risk factors identified. Traditional adult risk factors such as hypertension, diabetes and coagulopathy were rarely found.

Although this study has the obvious limitations of using a national database, it provides a glimpse of the problem. Compared to TIA, there were 5 times as many admissions for ischemic stroke during the same timeframe. Keep in mind though that TIAs in children aren’t as straightforward to diagnose, and it is likely that many were missed or misdiagnosed. Important questions regarding risk of subsequent stroke is difficult to determine but 4% also had a diagnosis code for stroke during the same hospitalization. Despite such dearth of knowledge, it is reassuring that none of the children died and 97% were discharged home. This of course should be no reason for complacency, and further study to identify risk factors, subsequent stroke risk and appropriate management should be pursued aggressively.