{
  "abstract": "Background Acute infection is an established risk factor for pediatric acute ischemic stroke (AIS), with prior case-control data demonstrating up to a 4-fold increase in risk. COVID-19’s contribution to pediatric AIS has been described only in very small single-center case series. Population-level estimates, particularly for COVID-19 history and post-COVID conditions as distinct risk categories, are scarce.Objective To determine whether COVID-19, and at which stage of infection, independently increases pediatric AIS risk compared to the general inpatient population and to children with other acute viral infections.Methods The 2022 HCUP Kids’ Inpatient Database (KID) was queried. AIS was defined by principal ICD-10-CM code I63. COVID-19 exposure was classified into mutually exclusive priority-ordered groups: MIS-C (M35.81), active COVID (U07.1/J12.82), COVID history/post-COVID (Z86.16/U09.9), COVID exposure only (Z20.822), other acute viral infections (B00-B39, A80-A89, J00-J22), and no infection. Survey-weighted logistic regression was fit across all discharges adjusting for age, sex, race, income, payer, congenital heart disease, coagulopathy, sickle cell disease, and hypertension, with no infection and other acute viral as sequential reference groups. An age-interaction model assessed age-group modification of active COVID effects.Results Approximately 1,118 survey-weighted AIS admissions were identified (COVID exposure only n=510; no infection n=384; COVID history/post-COVID n=119; COVID active n=58; other acute viral n=46; MIS-C n=1.4, treated descriptively). Any COVID code was associated with increased AIS odds after adjustment (aOR 1.55, 95% CI 1.25-1.91, p<0.001), versus an unadjusted OR of 5.72 (95% CI 4.81-6.81), reflecting substantial confounding. COVID history/post-COVID carried the strongest signal (aOR 2.18, 95% CI 1.62-2.94, p<0.001); active COVID was non-significant after adjustment (aOR 1.17, 95% CI 0.81-1.69, p=0.39), confirmed on sensitivity analysis restricting to U07.1 (aOR 1.26, 95% CI 0.87-1.81, p=0.22). In the omnibus model, other acute viral infections did not significantly differ from no infection (aOR 0.81, 95% CI 0.55-1.20, p=0.29). Using other acute viral as the reference, COVID history/post-COVID conferred 3-fold greater AIS odds (aOR 3.16, 95% CI 1.99-5.02, p<0.001); COVID active/MIS-C (aOR 1.81, 95% CI 1.09-2.98, p=0.021) and COVID exposure only (aOR 1.68, 95% CI 1.14-2.48, p=0.009) were also elevated. Active COVID effects were age-modified: risk was concentrated in neonates (aOR 22.1, 95% CI 10.1-48.1, p<0.001) with marked attenuation in children and adolescents (interaction OR 0.044 and 0.042, both p<0.001).Conclusion COVID-19 history and post-COVID conditions, but not acute infection, independently increased pediatric AIS risk, conferring over 3-fold greater odds than other acute viral illness. Among neonates, active COVID carries markedly elevated risk, suggesting age-dependent vulnerability. These findings support a predominantly post-infectious mechanism for COVID-associated pediatric stroke and have implications for surveillance in children with prior SARS-CoV-2 infection.Disclosures A. Devarajan: None. T. Shigematsu: None. D. Goldman: None. T. Hardigan: None. P. Morgenstern: None. S. Majidi: None. A. Berenstein: None. J. Fifi: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "A Devarajan"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "T Shigematsu"
    },
    {
      "affiliations": [
        "Icahn School of Medicine, New York City, NY"
      ],
      "name": "S Allen"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "BD Philbrick"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "D Goldman"
    },
    {
      "affiliations": [
        "Radiology, Mount Sinai Medical Center, New York, NY"
      ],
      "name": "JM Watchmaker"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "T Hardigan"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "P Morgenstern"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "S Majidi"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "A Berenstein"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY"
      ],
      "name": "J Fifi"
    }
  ],
  "title": "E-151 Prior COVID-19 infection is independently associated with risk of pediatric ischemic stroke: a nationwide analysis",
  "uid": "768ea2eb-b190-5b57-b64a-87e86fcac2e7"
}