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 accessOne-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 NeurologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Delay to diagnosis in acute pediatric arterial ischemic stroke.Stroke. 2009; 40: 58-64
- Delays in investigation and management of acute arterial ischaemic stroke in children.Dev Med Child Neurol. 2008; 50: 537-540
- Delayed diagnosis of acute ischemic stroke in children - a registry-based study in Switzerland.Swiss Med Wkly. 2011; 141: w13281
- Delayed recognition of initial stroke in children: need for increased awareness.Pediatrics. 2009; 124: e227-e234
- Diagnostic delays in paediatric stroke.J Neurol Neurosurg Psychiatry. 2015; 86: 917-921
- Emergence of the primary pediatric stroke center: impact of the thrombolysis in pediatric stroke trial.Stroke. 2014; 45: 2018-2023
- Early stroke recognition: developing an out-of-hospital NIH Stroke Scale.Acad Emerg Med. 1997; 4: 986-990
- The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field.Prehosp Emerg Care. 2004; 8: 46-50
- Paramedic identification of stroke: community validation of the Melbourne ambulance stroke screen.Cerebrovasc Dis. 2005; 20: 28-33
- The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument.Lancet Neurol. 2005; 4: 727-734
- 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
- Prehospital stroke scales in urban environments: a systematic review.Neurology. 2014; 82: 2241-2249
- 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
- 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
- Paramedic diagnosis of stroke: examining long-term use of the Melbourne Ambulance Stroke Screen (MASS) in the field.Stroke. 2010; 41: 1363-1366
- Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?.BMC Pediatr. 2011; 11: 93
COTS Stroke Alert Tool. Available at: http://www.goodhealthcolumbus.org/attachments/COTSStrokeAlertPostItPadsRevII124350.pdf. Accessed August 7, 2015.
- Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study.Lancet Neurol. 2014; 13: 35-43
- Mimics of childhood stroke: characteristics of a prospective cohort.Pediatrics. 2006; 118: 704-709
- Imaging data reveal a higher pediatric stroke incidence than prior US estimates.Stroke. 2009; 40: 3415-3421
- Stroke and nonstroke brain attacks in children.Neurology. 2014; 82: 1434-1440
- Seizures in acute childhood stroke.J Pediatr. 2012; 160: 291-296
- Seizures as a presenting symptom of acute arterial ischemic stroke in childhood.J Pediatr. 2011; 159: 479-483
- Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study.Stroke. 2011; 42: 613-617
- Paediatric stroke: pressing issues and promising directions.Lancet Neurol. 2015; 14: 92-102
Article info
Publication history
Published online: March 10, 2016
Accepted:
February 2,
2016
Received:
November 2,
2015
Footnotes
Financial disclosures: None.
Funding source: No specific support.
Conflict of interest: None.
Contributor's Statement Page: Dr. Neville identified the subjects, performed the chart reviews, collected the data, performed the initial data analysis, drafted the initial manuscript, and approved the final manuscript as submitted.
Dr. Lo designed the study, performed the final data analysis, revised the manuscript, and approved the final manuscript as submitted.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
