Medical Professional Publications

Searching for a Pediatric Ischemic Stroke Screening Tool

Columbus, OH - July 2016

Outside of the newborn stage, acute childhood ischemic stroke is rare, but conditions that mimic strokes are comparatively common. A tool that could help frontline providers such as emergency medical technicians and emergency department nurses quickly screen for pediatric stroke could improve initial care.

Since a number of validated adult stroke screening tools are already in use, clinician-researchers at Nationwide Children’s Hospital analyzed whether a representative one could work for children as well. A recent study published in Pediatric Neurology suggests an adult tool does not translate well for the pediatric population.

“It was neither sensitive nor specific,” says Warren Lo, MD, a neurologist, director of the Stroke and Vascular Anomalies Clinic at Nationwide Children’s and senior author of the article. “Our observation is that you can’t just take an adult tool off the shelf and apply it to children. This study, though, did provide clues as to what a pediatric stroke scale for kids may look like.”

The authors retrospectively applied the Central Ohio Trauma System (COTS) adult stroke scale to the examination records of 53 children with acute symptomatic acute ischemic stroke and 53 age-matched control subjects who presented with focal neurological deficits such as acute facial droop or hemiparesis. The COTS scale records four common signs of adult stroke: decreased consciousness, slurred speech, facial droop and unilateral arm drift or paralysis.

There was a non-significant trend for the pediatric patients with stroke to have a higher total COTS score than control patients. Decreased consciousness, slurred speech and facial droop did not distinguish the stroke or control groups.

Unilateral arm weakness, however, was significantly associated with the stroke group.  And that association is one of those clues that a pediatric stroke scale could be built from, says Dr. Lo, who is also a clinical professor of Pediatrics and Neurology at The Ohio State University College of Medicine.

Though not a part of the COTS tool, acute seizure significantly associated with the stroke group as well, and likely could also serve as a factor in the development of a pediatric stroke tool, Dr. Lo says. Creators of the tool should recognize that speech might not be as important a screening measures as in adults — very young children and those with certain underlying conditions may be pre-speech or non-verbal.

A pediatric stroke scale would be helpful, but it’s not clear who would take on the project, says Dr. Lo. A multi-institution collaboration would be essential to the success of the endeavor and significant research funding would be needed.   

Still, the opportunity to intervene early in children with acute ischemic stroke exists more often than one might suspect, Dr. Lo says. Recent studies have shown that the majority of children with a stroke seek care within three hours, while adults are more likely to wait.

“Families recognize when their children are having problems,” says Dr. Lo. “On the medical side, we need to have ways to recognize that too.”

Neville K, Lo W. Sensitivity and specificity of an adult stroke screening tool in childhood ischemic stroke. Pediatric Neurology. 2016 May;58:12-24.

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