Advertisement

Sensitivity and Specificity of an Adult Stroke Screening Tool in Childhood Ischemic Stroke

  • Kerri Neville
    Affiliations
    Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
    Search for articles by this author
  • Warren Lo
    Correspondence
    Communications should be addressed to: Dr. Lo; EDU 582; 700 Children's Drive; Columbus, OH 43205.
    Affiliations
    Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio

    Department of Neurology, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
    Search for articles by this author

      Abstract

      Background

      There are frequent delays in the diagnosis of acute pediatric ischemic stroke. A screening tool that could increase the suspicion of acute ischemic stroke could aid early recognition and might improve initial care. An earlier study reported that children with acute ischemic stroke have signs that can be recognized with two adult stroke scales. We tested the hypothesis that an adult stroke scale could distinguish children with acute ischemic stroke from children with acute focal neurological deficits not due to stroke.

      Methods

      We retrospectively applied an adult stroke scale to the recorded examinations of 53 children with acute symptomatic acute ischemic stroke and 53 age-matched control subjects who presented with focal neurological deficits. We examined the sensitivity and specificity of the stroke scale and the occurrence of acute seizures as predictors of stroke status.

      Results

      The total stroke scale did not differentiate children with acute ischemic stroke from those who had acute deficits from nonstroke causes; however, the presence of arm weakness was significantly associated with stroke cases. Acute seizures were significantly associated with stroke cases.

      Conclusions

      An adult stroke scale is not sensitive or specific to distinguish children with acute ischemic stroke from those with nonstroke focal neurological deficits. The development of a pediatric acute ischemic stroke screening tool should include arm weakness and perhaps acute seizures as core elements. Such a scale must account for the limitations of language in young or intellectually disabled children.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rafay M.F.
        • Pontigon A.M.
        • Chiang J.
        • et al.
        Delay to diagnosis in acute pediatric arterial ischemic stroke.
        Stroke. 2009; 40: 58-64
        • McGlennan C.
        • Ganesan V.
        Delays in investigation and management of acute arterial ischaemic stroke in children.
        Dev Med Child Neurol. 2008; 50: 537-540
        • Martin C.
        • von E.E.
        • El-Koussy M.
        • Boltshauser E.
        • Steinlin M.
        Delayed diagnosis of acute ischemic stroke in children - a registry-based study in Switzerland.
        Swiss Med Wkly. 2011; 141: w13281
        • Srinivasan J.
        • Miller S.P.
        • Phan T.G.
        • Mackay M.T.
        Delayed recognition of initial stroke in children: need for increased awareness.
        Pediatrics. 2009; 124: e227-e234
        • Mallick A.A.
        • Ganesan V.
        • Kirkham F.J.
        • et al.
        Diagnostic delays in paediatric stroke.
        J Neurol Neurosurg Psychiatry. 2015; 86: 917-921
        • Bernard T.J.
        • Rivkin M.J.
        • Scholz K.
        • et al.
        Emergence of the primary pediatric stroke center: impact of the thrombolysis in pediatric stroke trial.
        Stroke. 2014; 45: 2018-2023
        • Kothari R.
        • Hall K.
        • Brott T.
        • Broderick J.
        Early stroke recognition: developing an out-of-hospital NIH Stroke Scale.
        Acad Emerg Med. 1997; 4: 986-990
        • Llanes J.N.
        • Kidwell C.S.
        • Starkman S.
        • Leary M.C.
        • Eckstein M.
        • Saver J.L.
        The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field.
        Prehosp Emerg Care. 2004; 8: 46-50
        • Bray J.E.
        • Martin J.
        • Cooper G.
        • Barger B.
        • Bernard S.
        • Bladin C.
        Paramedic identification of stroke: community validation of the Melbourne ambulance stroke screen.
        Cerebrovasc Dis. 2005; 20: 28-33
        • Nor A.M.
        • Davis J.
        • Sen B.
        • et al.
        The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument.
        Lancet Neurol. 2005; 4: 727-734
        • Harbison J.
        • Hossain O.
        • Jenkinson D.
        • Davis J.
        • Louw S.J.
        • Ford G.A.
        Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test.
        Stroke. 2003; 34: 71-76
        • Brandler E.S.
        • Sharma M.
        • Sinert R.H.
        • Levine S.R.
        Prehospital stroke scales in urban environments: a systematic review.
        Neurology. 2014; 82: 2241-2249
        • Asimos A.W.
        • Ward S.
        • Brice J.H.
        • Rosamond W.D.
        • Goldstein L.B.
        • Studnek J.
        Out-of-hospital stroke screen accuracy in a state with an emergency medical services protocol for routing patients to acute stroke centers.
        Ann Emerg Med. 2014; 64: 509-515
        • Berglund A.
        • Svensson L.
        • Wahlgren N.
        • von Euler M.
        Face Arm Speech Time Test use in the prehospital setting, better in the ambulance than in the emergency medical communication center.
        Cerebrovasc Dis. 2014; 37: 212-216
        • Bray J.E.
        • Coughlan K.
        • Barger B.
        • Bladin C.
        Paramedic diagnosis of stroke: examining long-term use of the Melbourne Ambulance Stroke Screen (MASS) in the field.
        Stroke. 2010; 41: 1363-1366
        • Yock-Corrales A.
        • Babl F.E.
        • Mosley I.T.
        • Mackay M.T.
        Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?.
        BMC Pediatr. 2011; 11: 93
      1. COTS Stroke Alert Tool. Available at: http://www.goodhealthcolumbus.org/attachments/COTSStrokeAlertPostItPadsRevII124350.pdf. Accessed August 7, 2015.

        • Mallick A.A.
        • Ganesan V.
        • Kirkham F.J.
        • et al.
        Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study.
        Lancet Neurol. 2014; 13: 35-43
        • Shellhaas R.A.
        • Smith S.E.
        • O'Tool E.
        • Licht D.J.
        • Ichord R.N.
        Mimics of childhood stroke: characteristics of a prospective cohort.
        Pediatrics. 2006; 118: 704-709
        • Agrawal N.
        • Johnston S.C.
        • Wu Y.W.
        • Sidney S.
        • Fullerton H.J.
        Imaging data reveal a higher pediatric stroke incidence than prior US estimates.
        Stroke. 2009; 40: 3415-3421
        • Mackay M.T.
        • Chua Z.K.
        • Lee M.
        • et al.
        Stroke and nonstroke brain attacks in children.
        Neurology. 2014; 82: 1434-1440
        • Singh R.K.
        • Zecavati N.
        • Singh J.
        • et al.
        Seizures in acute childhood stroke.
        J Pediatr. 2012; 160: 291-296
        • Abend N.S.
        • Beslow L.A.
        • Smith S.E.
        • et al.
        Seizures as a presenting symptom of acute arterial ischemic stroke in childhood.
        J Pediatr. 2011; 159: 479-483
        • Ichord R.N.
        • Bastian R.
        • Abraham L.
        • et al.
        Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study.
        Stroke. 2011; 42: 613-617
        • Kirton A.
        • deVeber G.
        Paediatric stroke: pressing issues and promising directions.
        Lancet Neurol. 2015; 14: 92-102