Examination of pediatric hemorrhagic stroke incidence: A systematic review and meta-analysis.

Background: Pediatric hemorrhagic stroke (HS) poses a significant burden. We aimed to examine the incidence rate of pediatric hemorrhagic stroke globally.

Method: This systematic review and meta-analysis searched Medline via Ovid, Embase, EBCOHOST, Scopus and Google Scholar up to 6 March 2024 for observational studies included pediatrics' incidence rate of hemorrhagic stroke (PROSPERO: CRD42022312643). The screening process, data extraction, and quality assessment were undertaken by two reviewers. A random-effects model was used for the incidence rate meta-analysis while meta-regression and bias assessment were performed in Stata SE18.

Results: Twenty-two articles of 6315 records were included in the narrative synthesis. Twelve articles were included in the meta-analysis. The reported incidence rate in neonates (aged 0-28 days) ranged from 0.08 to 1.1 per 1,000 live births in three studies. In older pediatric population (aged ≤ 20 years), the incidence rate ranged from 0.59 to 5.1, 0.25 to 1.5 and 0.25 to 0.6 per 100,000 persons-years for all HS (n = 13), intracerebral hemorrhage (ICH) (n = 5) and subarachnoid hemorrhage (SAH) (n = 3), respectively. Meta-analysis showed a pooled incidence rate for all hemorrhagic stroke (n = 1810) of 1.45 (1.03, 2.04) per 100,000 person-years, I = 96.99 %. Studies that excluded traumatic injury had a lower incidence rate than those that included traumatic injury in the incidence rate calculation (1.22 vs 2.34 per 100,000 person-years, respectively).

Conclusions: The difference between incidence rates was detected between subgroups of HS (i.e., traumatic cases vs no traumatic cases). Further research is warranted to examine the impact of etiology on the incidence rate of stroke.