Abstract T MP61: Diagnostic Accuracy of Adult Bedside Stroke Recognition Tools in Childhood Stroke

Abstract

Objective: Bedside stroke recognition tools improve diagnostic accuracy in adult stroke. Our aim was to assess the diagnostic utility of the CPSS and ROSIER tools in children presenting to the emergency department (ED) with brain attack symptoms. Methods: The Cincinnati Prehospital Stroke Scale (CPSS ) and the Recognition of Stroke in the Emergency Room (ROSIER) tool were retrospectively applied to 101 consecutive children with stroke, presenting from 2003-2010, and 279 children with mimics, presenting to the ED from 2009-2010. A positive CPSS was defined as ≥1 positive sign (face or arm weakness, speech disturbance). A positive ROSIER was defined as a score of ≥1. Diagnostic accuracy of the tools in determining the patients’ true status were estimated for arterial (AIS), hemorrhagic (HS) and combined stroke subtypes versus mimics. Results: The CPSS and ROSIER tools correctly discriminated combined stroke subtypes from mimics (diagnostic odds ratio (DOR) 5.6 and 4.7 respectively) and AIS from mimics (DOR 15.1 and 13.4 respectively) but not HS from mimics (DOR 1.2 for both tools). CPSS and ROSIER accuracy were fair for AIS versus mimics (ROC 0.79 and 0.77 respectively), fair to poor for combined stroke subtypes versus mimics (ROC 0.70 and 0.68 respectively) and failed for HS versus mimics (ROC 0.51 and 0.52 respectively). Reasons for limited accuracy include different spectrum of mimics, lower overall prevalence, higher proportion of HS subtype and common seizure occurrence in childhood stroke. Conclusions: Adult stroke recognition tools correctly discriminate combined stroke types and AIS subtype from mimics but their limited accuracy suggest further modifications are required to improve diagnostic utility for identification of childhood stroke in the ED.