A proposed classification for subtypes of arterial ischaemic stroke in children

Wraige, Elizabeth; Pohl, Keith; Ganesan, Vijeya

doi:10.1017/s0012162205000484

Cited by 55 publications

(24 citation statements)

References 28 publications

(20 reference statements)

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“…13;14 Subsequent efforts toward childhood-specific nomenclature and classification in AIS have been proposed (The Pediatric Stroke Classification [PSC] and the Sebire Criteria), but no one system has been widely adopted. 15;16 …”

Section: Introductionmentioning

confidence: 99%

Towards a Consensus-Based Classification of Childhood Arterial Ischemic Stroke

Bernard¹,

Manco‐Johnson²,

Lo³

et al. 2012

Stroke

150

139

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Background and Purpose The implementation of uniform nomenclature and classification in adult arterial ischemic stroke (AIS) has been critical for defining outcomes and recurrence risks according to etiology and in developing risk-stratified treatments. In contrast, current classification and nomenclature in childhood AIS are often overlapping or contradictory. Our purpose was to develop a comprehensive consensus-based classification system for childhood AIS. Methods Utilizing a modified-Delphi method, members of the International Pediatric Stroke Study (IPSS) developed the Childhood AIS Standardized Classification and Diagnostic Evaluation (CASCADE) criteria. Two groups of pediatric stroke specialists from the IPSS classified seven test cases using two methods each: 1) classification typical of the individual clinician’s current clinical practice, 2) classification based on the CASCADE criteria. Group 1 underwent in-person training in the utilization of the CASCADE criteria. Group 2 classified the same cases via an online survey including definitions but without training. Inter-rater reliability (IRR) was assessed via multi-rater unweighted kappa statistic. Results In Group 1 (with training), IRR was improved using CASCADE criteria (κ=0.78, 95% CI=[0.49, 0.94]) compared to typical clinical practice (κ=0.40, 95%CI=[0.11, 0.60]). In Group 2 (without training), IRR was lower than among trained raters, (κ=0.61, 95%CI=[0.29,0.77]); but higher than current practice (κ=0.23, 95%CI=[0.03,0.36]). Conclusions A new, consensus-based classification system for childhood AIS, the CASCADE criteria, can be used to classify cases with good IRR. These preliminary findings suggest that the CASCADE criteria may be particularity useful in the setting of prospective multicenter studies in childhood-onset AIS, where standardized training of investigators is feasible.

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Section: Introductionmentioning

confidence: 99%

Towards a Consensus-Based Classification of Childhood Arterial Ischemic Stroke

Bernard¹,

Manco‐Johnson²,

Lo³

et al. 2012

Stroke

150

139

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“…Priority should be given to characterisation of the cerebral arterial circulation and to identification of potentially modifiable risk factors 3 11. In the present study, arteriopathies were identified in 10 of 29 patients (34.5%).…”

Section: Discussionmentioning

confidence: 57%

“…Patients were classified according to the previously proposed classification for subtypes of AIS in children11 and divided into two groups for analysis. Group I consisted of children with determined causes of AIS including arteriopathies and cardioembolism.…”

Section: Methodsmentioning

confidence: 99%

A right-to-left shunt in children with arterial ischaemic stroke

Benedik

Zaletel

Meglič

et al. 2011

Archives of Disease in Childhood

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“…All patients with undetermined etiology had normal investigations including cerebrovascular imaging, echocardiogram, and prothrombotic studies [14,15]. …”

Section: Methodsmentioning

confidence: 99%

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

et al. 2011

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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.

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A proposed classification for subtypes of arterial ischaemic stroke in children

Cited by 55 publications

References 28 publications

Towards a Consensus-Based Classification of Childhood Arterial Ischemic Stroke

Towards a Consensus-Based Classification of Childhood Arterial Ischemic Stroke

A right-to-left shunt in children with arterial ischaemic stroke

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

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