Emergency Department, Royal Children's Hospital, Melbourne, Australia.
BMC Pediatr. 2011 Oct 21;11:93. doi: 10.1186/1471-2431-11-93.
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 < 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.
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.
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.
已经证明，中风识别工具可以提高成人的诊断准确性。为了减少诊断延迟，需要开发一种类似的工具来用于儿童。关键的第一步是确定成人中风量表是否可以应用于儿童中风。
评估成人中风量表在儿童急性动脉缺血性中风（AIS）中的适用性。
回顾性地确定了 2003 年至 2008 年在三级急诊部（ED）就诊的年龄在 1 个月至<18 岁的经放射学证实的急性 AIS 患儿。提取体征、症状、危险因素和初始治疗。回顾性地对所有患者应用两种成人中风识别工具；ROSIER（急诊室中风识别）和 FAST（面部手臂言语测试）量表，以确定测试的敏感性。
共确定了 47 例 AIS 患儿。34 例为前循环，12 例为后循环，1 例为前循环和后循环梗死。中位年龄为 9 岁，51%为男性。从症状发作到 ED 就诊的中位时间为 21 小时，但三分之一的患儿在 6 小时内就诊。最常见的首发中风症状是手臂（63%）、面部（62%）、腿部无力（57%）、言语障碍（46%）和头痛（46%）。最常见的体征是手臂（61%）、面部（70%）或腿部无力（57%）和构音障碍（34%）。36 例（78%）患儿 FAST 至少有 1 个阳性变量，38 例（81%） ROSIER 评分≥1。后循环中风患儿阳性评分较低。
儿科中风的表现与成人中风相似。两种成人中风识别工具在放射学证实的儿童 AIS 中具有较好的敏感性，但需要进一步开发和修改。在中风和非中风性脑卒的前瞻性队列中，还需要确定这些工具的特异性。
