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A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology
Published on: February 7, 2015
Measuring outcome after arterial ischemic stroke in childhood with two different instruments
M M M Bulder1, P M Hellmann, O van Nieuwenhuizen
1Department of Child Neurology and Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. M.M.M.Bulder@umcutrecht.nl
Insights
The modified Rankin Scale (mRS) combined with school type is a practical and effective measure for assessing childhood stroke outcomes, correlating well with quality of life. This method is easier to use than the Pediatric Stroke Outcome Measure (PSOM).
Area of Science:
- Pediatric neurology
- Clinical outcome assessment
- Childhood cerebrovascular disease
Background:
- Assessing outcomes in childhood stroke is crucial for clinical practice and research.
- Two common outcome measures, the Pediatric Stroke Outcome Measure (PSOM) and the modified Rankin Scale (mRS), are frequently used.
- This study aimed to compare the utility of these two measures.
Purpose of the Study:
- To compare the Pediatric Stroke Outcome Measure (PSOM) with the modified Rankin Scale (mRS) combined with school attendance for assessing outcomes in children with arterial ischemic stroke (AIS).
- To evaluate the correlation of these measures with pediatric quality of life (PedsQL) and general functioning visual analogue scale (VAS) scores.
Main Methods:
- Compared dichotomized PSOM and mRS (with school attendance) in 40 children with AIS.
- Assessed correlation with PedsQL questionnaires and VAS scores (parent and investigator reported).
Main Results:
- Outcome classification was concordant between PSOM and mRS in 88% of children.
- The mRS combined with school performance better reflected investigator impressions (VAS ≥7.5) in cases of discordance.
- Both PSOM and mRS (with school performance) showed significant correlation with higher PedsQL and VAS scores in children with good outcomes.
Conclusions:
- The mRS combined with school type is a practical, effective outcome measure for childhood AIS.
- This combined measure correlates well with quality of life and general functioning assessments.
- The mRS approach is simpler, captures cognitive aspects, and aligns better with clinical judgment than PSOM.
Background:
Assessment of outcome after childhood stroke is important both for clinical practice and for research purposes. The objective of this study was to compare two frequently used outcome measures.
Methods:
In 40 children with arterial ischemic stroke (AIS), dichotomized outcome obtained from the Pediatric Stroke Outcome Measure (PSOM) was compared with a dichotomized modified Rankin Scale (mRS) combined with information on type of school attendance. In addition, we compared dichotomized outcome, obtained from the PSOM and the mRS combined with school attendance, with the results of pediatric quality of life (PedsQL) questionnaires and the impressions of the child's general functioning on a visual analogue scale (VAS) that was filled out by parents and investigators.
Results:
In 35 children (88%), outcome classification was concordant between the two outcome measures. Five children had a poor outcome according to the PSOM and good outcome with the mRS including school performance. In these patients, mRS outcome classification agreed better with the impression of the investigators, as reflected by VAS scores ≥7.5. For both the PSOM and mRS in combination with school performance, patients with a good outcome had significantly higher PedsQL and VAS scores than those with a poor outcome (p values <0.01 for all comparisons). VAS scores of investigators and parents correlated significantly with PedsQL.
Conclusions:
In children with AIS, both PSOM and mRS combined with school type correlated significantly with quality of life and VAS scores of general functioning. The mRS combined with school type is easier to obtain than the PSOM, reflects function rather than deficits, includes an important measure of cognitive outcome, and corresponds better with the doctor's impression of outcome.
