Abstract 2375: Pediatric Stroke Outcome Measure Predicts Cognitive And Functional Deficits After Childhood Ischemic Stroke

Abstract

BACKGROUND: The Pediatric Stroke Outcome Measure (PSOM), a 10 point scale based on 5 domains, is one of the few measures of outcome in pediatric stroke. The PSOM has been used to estimate global deficit for studies of stroke outcome and post-stroke quality of life, but its sensitivity to cognitive and functional impairments has received little attention. To address this question, we examined the ability of the PSOM to predict cognitive functioning and behavior after childhood stroke. METHODS: Children ages 6-15 years who had neonatal or childhood onset arterial ischemic stroke were identified by chart review at the Nationwide Children’s Hospital (Columbus, OH, USA) and Royal Children’s Hospital (Melbourne, Australia). Subjects were included if they could complete the test battery. Age- and gender-matched children who had asthma were selected as controls. Stroke cases were assessed with the PSOM and had an MRI brain scan after the acute phase of stroke. Cases and controls underwent functional assessments at least 1 year after the incident stroke. The battery of tests and ratings included the Child Behavior Checklist, Adaptive Behavior Assessment System, Child and Adolescent Scales of Participation, the Wechsler Abbreviated Scales of Intelligence (WASI), and the WISC-4 Processing Speed Index. Infarct volumes were measured by manual segmentation. RESULTS: The sample included 36 children with perinatal or childhood stroke, and 15 controls. Median age at assessment was 8.7 yrs (IQR 6.9-11.9) and median time after presentation was 5.1 yrs (IQR 2.8-7.4). The total PSOM was significantly and inversely related to all measures of cognitive functioning (p range for WISC and WASI 0.001-0.048), multiple measures of adaptive behavior (p range for ABAS scales 0.000-0.031), and all measures of social participation (p range for CASP scales 0.000-0.007). The cognitive/behavioral (C/B) scale of the PSOM was significantly and inversely related to all measures of social participation (p values for CASP 0.000) and multiple measures of adaptive behavior (p range for ABAS scales 0.001-0.057), and positively related to multiple measures of behavior problems (p range for CBCL scales 0.001-0.037). Conclusions: The total PSOM can predict multiple areas of intellectual impairment, and also predicts impairment in adaptive behavior and social participation. In addition the C/B scale can predict behavior problems. The C/B scale depends upon parental report and the clinician's impression, so it is noteworthy that abnormalities on this four-point scale can suggest impairments in a broad range of domains. In addition to a quantitative measure of stroke outcome, the PSOM can serve as a useful screening tool for the identification of intellectual or functional deficits that warrant further investigation for appropriate intervention.