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Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED
Thomas J Abramo1, Z Leah Harris2, Mark Meredith3
1Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR.
Insights
Cerebral oximetry and cerebral blood volume index (CBVI) show promise in detecting pediatric strokes. A regional cerebral oxygen saturation (rcso2) side difference greater than 10 or readings below 50% indicate stroke with 100% accuracy.
Area of Science:
- Neurology
- Pediatric Medicine
- Medical Technology
Background:
- Pediatric stroke recognition and activation face delays despite existing systems.
- Objective tools are crucial for improving pediatric stroke detection and activation.
- Regional cerebral oxygen saturation (rcso2) and cerebral blood volume index (CBVI) can identify abnormal cerebral physiology.
Purpose of the Study:
- To evaluate the efficacy of cerebral oximetry in detecting strokes in pediatric patients.
- To assess the utility of rcso2 and CBVI in identifying stroke alerts and overall stroke cases.
Main Methods:
- Analysis of left and right rcso2, and their side differences in stroke versus non-stroke pediatric patients.
- Correlation of rcso2 and CBVI values with stroke location and type (hemorrhagic vs. ischemic).
Main Results:
- Lower rcso2 and CBVI values were observed in stroke patients compared to non-stroke patients (P < .0001).
- Greater rcso2 side differences were found in stroke patients (P < .0001).
- An rcso2 side difference >10 demonstrated 100% positive predictive value for stroke, with similar findings for readings <50%.
Conclusions:
- Cerebral oximetry (rcso2) and CBVI effectively detect abnormal cerebral physiology, stroke location, and type.
- Specific thresholds (rcso2 side difference >10 or <50%) indicate stroke with high accuracy.
- Cerebral oximetry offers a potential non-neurologist tool to expedite pediatric stroke diagnosis and management.
Background:
Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rcso2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
Objective:
To determine cerebral oximetry in detecting strokes in stroke alert and overall stroke patients.
Method:
Left rcso2, right rcso2, and rcso2 side differences for stroke, location, and types were analyzed.
Results:
Compared with stroke alert (n = 25) and overall strokes (n = 52), rcso2 and CBVI were less than those in nonstrokes (n = 133; P < .0001). Rcso2 side differences in stroke alert and overall strokes were greater than in nonstrokes (P < .0001). Lower rcso2 and CBVI correlated with both groups' stroke location, left (P < .0001) and right rcso2 (P = .004). Rcso2 differences greater than 10 had a 100% positive predictive value for stroke. Both groups' rcso2 and CBVI side differences were consistent for stroke location and type (P < .0001). For both groups, left rcso2 and CBVI were greater than those of the right (P < .0001). Hemorrhagic strokes had lower bilateral rcso2 and CBVI than did ischemic strokes (P < .001).
Conclusions:
Cerebral oximetry and CBVI detected abnormal cerebral physiology, stroke location, and type (hemorrhagic or ischemic). Rcso2 side differences greater than 10 or rcso2 readings less than 50% had a 100% positive predictive value for stroke. Cerebral oximetry has shown potential as a detection tool for stroke location and type in a pediatric stroke alert and nonalert stroke patients. Using cerebral oximetry by the nonneurologist, we found that the patient's rcso2 side difference greater than 10 or one or both sides having less than 50% rcso2 readings suggests abnormal hemispheric pathology and expedites the patient's diagnosis, neuroresuscitation, and radiologic imaging.
