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Published on: March 11, 2021
Development and Validation of a Postprocedure Stroke Screening Tool in Children With Cardiac Disease
Dana B Harrar1, Catherine L Salussolia2, Louisa G Keith2
1Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Insights
A new bedside screening tool effectively identifies arterial ischemic stroke in children after cardiac catheterization. This tool demonstrates high sensitivity and specificity for early stroke detection in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Neurology
- Medical Diagnostics
Background:
- Cardiac catheterization in children with heart disease poses a risk for arterial ischemic stroke.
- Early identification of post-procedure stroke is crucial for timely intervention.
Purpose of the Study:
- To develop and validate a bedside screening tool for detecting arterial ischemic stroke in pediatric patients post-cardiac catheterization.
- To assess the diagnostic performance of the novel screening tool.
Main Methods:
- A postprocedure stroke screen was developed, including history, responsiveness, command following, speech, symmetry, seizures, and caregiver concern.
- The tool's performance was evaluated by comparing a retrospective cohort of 21 stroke patients with 100 prospective control patients.
Main Results:
- The screening tool achieved a high Youden index (0.810–0.937) at specific thresholds.
- Sensitivity and specificity for detecting stroke were greater than 0.9.
- The area under the receiver operating characteristic curve was high (0.931–0.946).
Conclusions:
- A novel bedside screening tool demonstrates high accuracy in identifying postcatheterization arterial ischemic stroke in children.
- The developed tool offers a sensitive and specific method for early stroke detection in this pediatric population.
Abstract:
BackgroundCardiac catheterization in children with heart disease is associated with an increased risk of arterial ischemic stroke. We created and evaluated the diagnostic performance of a bedside screening tool administered postprocedure to identify arterial ischemic stroke.MethodsWe developed a postprocedure stroke screen comprising history of stroke, responsiveness, command following, speech, facial and limb strength symmetry, new seizure, and caregiver concern. We compared the performance of the screening tool in a retrospective cohort of 21 patients with a postcatheterization arterial ischemic stroke and a prospective cohort of 100 consecutive control patients after cardiac catheterization.ResultsThe postprocedure stroke screen delivered a maximum Youden index ranging from 0.810 to 0.937 at threshold scores of 2 or 2.5 and gave a sensitivity and specificity >0.9. The area under the receiver operating characteristic curve ranged from 0.931 to 0.946.ConclusionsWe developed a screening tool with high sensitivity and specificity to identify postcatheterization arterial ischemic stroke in children.
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