Introduction: More than 50% of childhood stroke survivors suffer long term impairments but known factors contributing to poor outcomes are limited. This study aims to describe factors associated with mortality, neurological disability and recurrence in childhood arterial ischaemic stroke (AIS) four years following diagnosis.

Methods: Prospective single-centre study of consecutive children aged 29 days-18 years with first arterial ischemic stroke (AIS), were recruited from 2003 to 2013. The NINDS common data element framework was used to select risk factors, laboratory and radiological variables of interest.  The Paediatric Stroke Outcome Measure (PSOM) was used for categorisation of outcome as good (0-0.5) or poor (≥1). Factors associated with poorer outcomes in terms of death, neurological impairment are presented as hazards ratios (HR) with 95% confidence intervals.

Results: 125 cases of childhood AIS were identified. 8% of children died, 27% had recurrent events. 51% of children had poor neurological outcome (total PSOM≥1); motor impairment was the most common deficit (28%). Prothrombotic disorders (HR 5.1; p=0.01) and acute surgical intervention for raised intracranial pressure (HR=4.8; p=0.05) were associated with death.  Arteriopathies (HR 3.03; p=0.002) and cardiac disorders (HR 1.55; p=0.03) were associated with AIS recurrence. The presenting symptom of dysequilibrium (HR 3.7; p=0.03) was associated with poorer neurological outcome.

Conclusions: The economic and social costs of childhood AIS are substantial  The findings that arteriopathies and cardiac disorders are a risk factor for recurrence is consistent with data from overseas. These will inform development of longitudinal multicentre Australian studies of childhood AIS.