Temporal trends in incidence and nationwide estimates of first-ever arterial stroke in children: Dijon Stroke Registry (1985-2025)

Introduction: Childhood arterial stroke is a rare but serious condition, and data on long-term trends in incidence are limited. This population-based study aimed to assess incidence rates, characterize secular trends, and provide nationwide estimations of childhood arterial stroke beyond the neonatal period. Methods: All cases of first-ever arterial stroke (ischemic stroke, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage) among children aged >28 days and <18 years were prospectively identified using the population-based Dijon Stroke Registry, France, between 1985 and 2025. Incidence rates were calculated and expressed according to five time periods. The annual number of children with first-ever stroke in France was estimated by standardization to sex-specific rates of the last study period (2017-2025), and 2022 French population as the denominator. Results: Among 1,037,746 person-years <18 years old, 26 children experienced a first-ever arterial stroke (15 girls and 11 boys, median age: 8.5 [IQR: 4-14] years). Among them, 17 (65.4%) had ischemic stroke, 8 (30.8%) had spontaneous intracerebral hemorrhage, and 1 (3.8%) had subarachnoid hemorrhage. The overall incidence was 2.5 per 100,000 children per year (95% CI: 1.64-3.67), with similar rates between girls (rate: 2.97; 95% CI: 1.66-4.88) and boys (rate: 2.07; 95% CI: 1.03-3.71) (sex IRR boys/girls: 0.70; 95% CI: 0.29-1.63, p=0.19). Although the lowest incidence was observed during the first study period (1985-1992, rate: 0.99; 95% CI: 0.12-3.57), and fluctuations were observed across study periods, incidence remained stable over time. Based on national extrapolation, we estimated that 373 cases occurred annually in France in the most recent period. Conclusions: First-ever arterial stroke in children remains rare, with no significant apparent temporal change over the past forty years.