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Sensitivity and Specificity of an Adult Stroke Screening Tool in Childhood Ischemic Stroke
1Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
Insights
Adult stroke scales are not effective for diagnosing acute pediatric ischemic stroke. Future screening tools should incorporate arm weakness and seizures, considering language barriers in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Diagnostic Tools
Background:
- Acute pediatric ischemic stroke diagnosis is often delayed.
- Early recognition and improved care are needed.
- Adult stroke scales may identify pediatric stroke signs.
Purpose of the Study:
- Test if adult stroke scales can distinguish pediatric ischemic stroke from other causes of focal neurological deficits.
- Evaluate the utility of adult stroke scales in pediatric stroke diagnosis.
Main Methods:
- Retrospective analysis of 53 children with acute ischemic stroke and 53 controls.
- Applied an adult stroke scale to recorded examinations.
- Assessed sensitivity, specificity, and seizure occurrence as predictors.
Main Results:
- The total adult stroke scale did not differentiate stroke from non-stroke cases.
- Arm weakness was significantly associated with stroke.
- Acute seizures were also significantly associated with stroke.
Conclusions:
- Adult stroke scales lack sensitivity and specificity for pediatric ischemic stroke.
- Pediatric stroke screening tools should include arm weakness and seizures.
- Consideration for language limitations in young or disabled children is crucial.
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.
