Cardiac 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.
Methods
We 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.
Results
The 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.
Conclusions
We developed a screening tool with high sensitivity and specificity to identify postcatheterization arterial ischemic stroke in children.
AsakaiHCardamoneMHutchinsonD, et al.Arterial ischemic stroke in children with cardiac disease. Neurology. 2015;85(23):2053-2059. doi:https://doi.org/10.1212/WNL.0000000000002036
SrinivasanJMillerSPPhanTGMackayMT. Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics. 2009;124(2):e227-e234. doi:https://doi.org/10.1542/peds.2008-3544
McGlennanCGanesanV. Delays in investigation and management of acute arterial ischaemic stroke in children. Dev Med Child Neurol. 2008;50(7):537-540. doi:https://doi.org/10.1111/j.1469-8749.2008.03012.x
11.
HarrarDBSalussoliaCLKapurK, et al.A stroke alert protocol decreases the time to diagnosis of brain attack symptoms in a pediatric emergency department. J Pediatr. 2020;216:136-141.e6. doi:https://doi.org/10.1016/j.jpeds.2019.09.027
12.
WhartonJDBarryMMLeeCAMasseyKLadnerTRJordanLC. Pediatric acute stroke protocol implementation and utilization over 7 years. J Pediatr. 2020;220:214-220.e1. doi:https://doi.org/10.1016/j.jpeds.2020.01.067
13.
LadnerTRMahdiJGindvilleMC, et al.Pediatric acute stroke protocol activation in a children’s hospital emergency department. Stroke. 2015;46(8):2328-2331. doi:https://doi.org/10.1161/STROKEAHA.115.009961
14.
CatenaccioERiggsBJSunLR, et al.Performance of a pediatric stroke alert team within a comprehensive stroke center. J Child Neurol. 2020;35(9):571-577. doi:https://doi.org/10.1177/0883073820920111
15.
DeLarocheAMSivaswamyLFarooqiAKannikeswaranN. Pediatric stroke clinical pathway improves the time to diagnosis in an emergency department. Pediatr Neurol. 2016;65:39-44. doi:https://doi.org/10.1016/j.pediatrneurol.2016.09.005
16.
LauzierDCGalardiMMGuilliamsKP, et al.Pediatric thrombectomy: design and workflow lessons from two experienced centers. Stroke. 2021;52(4):1511-1519. doi:https://doi.org/10.1161/STROKEAHA.120.032268
17.
GladkikhMMcMillanHJAndradeA, et al.Pediatric hyperacute arterial ischemic stroke pathways at Canadian tertiary care hospitals. Can J Neurol Sci J Can Sci Neurol.2021;11:1-8. Published Online February. doi:https://doi.org/10.1017/cjn.2021.27
18.
TaboneLMediamolleNBellesmeC, et al.Regional pediatric acute stroke protocol: initial experience during 3 years and 13 recanalization treatments in children. Stroke. 2017;48(8):2278-2281. doi:https://doi.org/10.1161/STROKEAHA.117.016591
19.
HarrarDBBenedettiGMJayakarA, et al. Pediatric acute stroke protocols in the United States and Canada. J Pediatr. 2021:S0022-3476(21):01048-9. Published online November 11. doi:https://doi.org/10.1016/j.jpeds.2021.10.048
20.
ShackMAndradeAShah-BasakPP, et al.A pediatric institutional acute stroke protocol improves timely access to stroke treatment. Dev Med Child Neurol. 2017;59(1):31-37. doi:https://doi.org/10.1111/dmcn.13214
HarbisonJHossainOJenkinsonDDavisJLouwSJFordGA. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003;34(1):71-76. doi:https://doi.org/10.1161/01.str.0000044170.46643.5e
23.
KidwellCSStarkmanSEcksteinMWeemsKSaverJL. Identifying stroke in the field: prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke. 2000;31(1):71-76. doi:https://doi.org/10.1161/01.str.31.1.71
NorAMMcAllisterCLouwSJ, et al.Agreement between ambulance paramedic- and physician-recorded neurological signs with Face Arm Speech Test (FAST) in acute stroke patients. Stroke. 2004;35(6):1355-1359. doi:https://doi.org/10.1161/01.STR.0000128529.63156.c5
26.
NorAMDavisJSenB, et al.The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005;4(11):727-734. doi:https://doi.org/10.1016/S1474-4422(05)70201-5
27.
BrayJEMartinJCooperGBargerBBernardSBladinC. Paramedic identification of stroke: community validation of the Melbourne ambulance stroke screen. Cerebrovasc Dis Basel Switz. 2005;20(1):28-33. doi:https://doi.org/10.1159/000086201
28.
ChenkinJGladstoneDJVerbeekPR, et al.Predictive value of the Ontario Prehospital Stroke Screening Tool for the identification of patients with acute stroke. Prehosp Emerg Care. 2009;13(2):153-159. doi:https://doi.org/10.1080/10903120802706146
29.
StudnekJRAsimosADoddsJSwansonD. Assessing the validity of the Cincinnati Prehospital Stroke Scale and the Medic Prehospital Assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care. 2013;17(3):348-353. doi:https://doi.org/10.3109/10903127.2013.773113
30.
Yock-CorralesABablFEMosleyITMackayMT. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?BMC Pediatr. 2011;11(93). doi:https://doi.org/10.1186/1471-2431-11-93
31.
MackayMTChurilovLDonnanGABablFEMonagleP. Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics. Neurology. 2016;86(23):2154-2161. doi:https://doi.org/10.1212/WNL.0000000000002736
32.
KirschenMPBlinderJDewittA, et al.Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units. Cardiol Young. 2018;28(12):1457-1462. doi:https://doi.org/10.1017/S1047951118001634
33.
KirschenMPSmithKASnyderM, et al.Serial Neurologic Assessment in Pediatrics (SNAP): a new tool for bedside neurologic assessment of critically ill children. Pediatr Crit Care Med. 2021;22(5):483. doi:https://doi.org/10.1097/PCC.0000000000002675
34.
AdamsHPDavisPHLeiraEC, et al.Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999;53(1):126-131. doi:https://doi.org/10.1212/wnl.53.1.126
35.
IchordRNBastianRAbrahamL, et al.Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study. Stroke. 2011;42(3):613-617. doi:https://doi.org/10.1161/STROKEAHA.110.607192
36.
McLellanMCGauvreauKConnorJA. Validation of the children’s hospital early warning system for critical deterioration recognition. J Pediatr Nurs. 2017;32:52-58. doi:https://doi.org/10.1016/j.pedn.2016.10.005
37.
AbendNSBeslowLASmithSE, et al.Seizures as a presenting symptom of acute arterial ischemic stroke in childhood. J Pediatr. 2011;159(3):479-483. doi:https://doi.org/10.1016/j.jpeds.2011.02.004
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