Abstract
BackgroundStroke recognition tools have been shown to improve diagnostic accuracy in adults. Development of a similar tool in children is needed to reduce lag time to diagnosis. A critical first step is to determine whether adult stoke scales can be applied in childhood stroke.Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS)MethodsChildren aged 1 month to < 18 years with radiologically confirmed acute AIS who presented to a tertiary emergency department (ED) (2003 to 2008) were identified retrospectively. Signs, symptoms, risk factors and initial management were extracted. Two adult stroke recognition tools; ROSIER (Recognition of Stroke in the Emergency Room) and FAST (Face Arm Speech Test) scales were applied retrospectively to all patients to determine test sensitivity.Results47 children with AIS were identified. 34 had anterior, 12 had posterior and 1 child had anterior and posterior circulation infarcts. Median age was 9 years and 51% were male. Median time from symptom onset to ED presentation was 21 hours but one third of children presented within 6 hours. The most common presenting stroke symptoms were arm (63%), face (62%), leg weakness (57%), speech disturbance (46%) and headache (46%). The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on FAST and 38 (81%) had a positive score of ≥1 on the ROSIER scale. Positive scores were less likely in children with posterior circulation stroke.ConclusionThe presenting features of pediatric stroke appear similar to adult strokes. Two adult stroke recognition tools have fair to good sensitivity in radiologically confirmed childhood AIS but require further development and modification. Specificity of the tools also needs to be determined in a prospective cohort of children with stroke and non-stroke brain attacks.
Highlights
Stroke recognition tools have been shown to improve diagnostic accuracy in adults
The most common signs were arm (61%), face (70%) or leg weakness (57%) and dysarthria (34%). 36 (78%) of children had at least one positive variable on Face Arm Speech Test (FAST) and 38 (81%) had a positive score of ≥1 on the Recognition of Stroke in the Emergency Department (ROSIER) scale
Recent studies have confirmed that diagnostic delays, are a key factor impacting on access to acute stroke interventions in children [1,2,3,4,5] Stroke symptoms in children are often attributed to other problems such as migraine, encephalitis, tumors or Todd’s paralysis due to limited knowledge about the signs and symptoms of stroke amongst primary care physicians, pediatricians and emergency physicians [5]
Summary
Stroke recognition tools have been shown to improve diagnostic accuracy in adults. Our objective was to assess the applicability of adult stroke scales in childhood arterial ischemic stroke (AIS). Use of the Recognition of Stroke in the Emergency Department (ROSIER) tool by emergency physicians has been shown to have good sensitivity and specificity in differentiating between stroke and non-stroke [9]. Development of similar tools may decrease time to stroke diagnosis in children but it is unclear whether pediatric stroke has similar presenting characteristics to adult stroke. Our aim was to retrospectively describe the spectrum of symptoms and signs in children presenting to a tertiary emergency department (ED) with acute arterial ischemic stroke (AIS). We hypothesised that the presenting characteristics of childhood stroke in children are similar to those encountered in adults
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