Childhood stroke patients with hyperglycemia may be more at risk for disability, according to a Vanderbilt University Medical Center (VUMC) study that sought to determine if vital sign measurements and blood glucose levels could be associated with poor neurological outcomes.
The study, published May 23 in JAMA Neurology, sought to establish better treatment guidelines for childhood ischemic strokes. It is the first to investigate in pediatric patients the effect of blood glucose levels and fever on neurological outcomes, and it contradicted a 2013 study that suggested hypertension was a risk factor for poor outcomes with childhood strokes.
However, more research on a wider scale is needed to provide evidence-based medical management guidelines, said Lori Jordan, M.D., Ph.D., director of the Pediatric Stroke Program at Monroe Carell Jr. Children’s Hospital.
“What is needed are some pretty detailed prospective observational studies, which take a lot of time and some money, but they are hard to fund,” Jordan said.
The VUMC study was a retrospective review of 98 non-diabetic children who had suffered strokes between the ages of 6 months and 14 years. The median age for the study group was 6 years.
Although elevated blood sugar levels after a stroke were associated with poor outcomes, hyperglycemia was not the biggest risk factor for poor outcome. Large stroke size was. An infarct size of 4 percent or greater of brain volume — a measurement of a stroke’s severity and damage — had the strongest association with poor outcomes. While this association was to be expected, Jordan said, the role that elevated blood sugar levels may play had not been previously established.
The review of patient records between July 2009 and December 2013 showed no association of fever or hypertension with poor outcomes.
“This study methodology is not ideal,” Jordan admitted. “It is a retrospective review of charts. Blood pressures and blood glucose measurements weren’t collected systematically. We weren’t able to tell if children were fasting or not fasting when their blood sugars were checked. We had to rely on information in the patient’s chart. It is a first step.”
Jordan is working with colleagues at other children’s hospitals to set up a more controlled observational study and secure funding for it.
“Observational research is often difficult to fund because it is not exciting to funding agencies,” she said. “But you have to understand the background frequency and severity of a problem before you can decide how you should intervene.”
