Outcome after ischaemic stroke in childhood
1Institute of Child Health, University College London, UK. V.Ganesan@ich.ucl.ac.uk
Insights
Parental questionnaires effectively assessed outcomes for pediatric ischemic stroke patients. Younger age at stroke onset was the primary predictor of adverse outcomes, impacting daily life significantly.
Area of Science:
- Pediatric neurology
- Childhood stroke outcomes
- Neurodevelopmental disorders
Background:
- Pediatric ischemic stroke is a significant cause of acquired childhood brain injury.
- Understanding long-term outcomes is crucial for effective management and rehabilitation.
- Parental perception plays a key role in assessing functional recovery.
Purpose of the Study:
- To investigate the outcomes of pediatric ischemic stroke using parental questionnaires.
- To validate parental reports against clinical and neuropsychological assessments.
- To identify predictors of adverse outcomes in children following ischemic stroke.
Main Methods:
- A retrospective study utilizing parental questionnaires for 90 children with ischemic stroke (1990-1996).
- Functional assessments by physiotherapists and occupational therapists, and neuropsychological evaluations were used for validation.
- Analysis of clinical and radiological factors in relation to outcome.
Main Results:
- 14% of children had no residual impairments; 40% had good outcomes, and 60% had poor outcomes impacting daily life.
- Good agreement was found between parental reports and qualitative professional assessments, but fair to moderate agreement with quantitative neuropsychological measures.
- Younger age at the time of stroke was the only significant predictor of adverse outcome.
Conclusions:
- Parental questionnaires are a valuable tool for assessing pediatric ischemic stroke outcomes, particularly for physical impairments.
- Younger children experiencing ischemic stroke face a higher risk of long-term adverse effects.
- Further research may explore discrepancies in parental perception of cognitive versus physical outcomes.
Abstract:
A parental questionnaire was used to investigate the outcome for children who had had ischaemic stroke, who were seen at Great Ormond Street Hospital, London between 1990 and 1996. The results of functional assessments carried out by a physiotherapist and an occupational therapist, and of quantitative evaluations carried out by a neuropsychologist were used for validation where possible. The relationship between clinical and radiological factors and outcome were examined. The children were aged between 3 months and 15 years at the time of stroke (median age 5 years) and the period of follow-up ranged from 3 months to 13 years (median duration 3 years). Of the 90 children for whom data were obtained, 13 (14%) had no residual impairments. Outcome was good in 37 children (40%) and poor in 53 (60%) (defined according to whether impairments interfered with daily life). Agreement, as measured by Cohen's kappa, was good or very good between the parents' responses and the qualitative measures provided by the medical professionals and the therapists, but only fair to moderate for the quantitative measures provided by the neuropsychologists. This may reflect different parental perceptions of the physical and cognitive aspects of outcome. Younger age at time of the stroke was the only significant predictor of adverse outcome.
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