Adriana Yock-Corrales

AM Nor

Australasian College for Emergency Medicine

C McGlennan

CS Kidwell

E Wraige

ET Miller

Franz E Babl

G Sebire

Ian T Mosley

J Harbison

J Srinivasan

LR Caplan

LV Gabis

Mark T Mackay

MF Rafay

PA Barber

PC Nayana Prabha

PJ Hand

R Askalan

R Kothari

S Chabrier

SS Rathore

BMC Pediatrics

English

PubMed

Springer - Publisher Connector

Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

Yock-Corrales, Adriana

Babl, Franz

Mosley, Ian

Mackay, Mark

Monash University Research Repository

Abstract
          
            Background
            Stroke 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)
          
          
            Methods
            Children aged 1 month to &lt; 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.
          
          
            Results
            47 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.
          
          
            Conclusion
            The 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.
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Crossref

AM: Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology

Delayed recognition of initial stroke in children: need for increased awareness. Pediatrics

Deveber GA: Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke

Early stroke recognition: Developing an out-of-hospital NIH Stroke Scale. Academic Emergency Medicine

GA: Agreement between ambulance paramedic- and physician-recorded

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GA: The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol

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JL: Identifying stroke in the field - Prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke

NJ: Time lag to diagnosis of stroke in children. Pediatrics

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Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?

Abstract

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Springer - Publisher Connector

Springer - Publisher Connector

Monash University Research Repository

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