Abramo Thomas J, Harris Z Leah, Meredith Mark, Crossman Kristen, Seupaul Rawle, Williams Abby, McMorrow Sheila, Dindo Jennifer, Gordon Angela, Melguizo-Castro Maria, Hu Zhuopei, Nick Todd
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR.
Department of Pediatrics, Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Am J Emerg Med. 2015 Nov;33(11):1622-9. doi: 10.1016/j.ajem.2015.07.037. Epub 2015 Jul 22.
Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rcso2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
To determine cerebral oximetry in detecting strokes in stroke alert and overall stroke patients.
Left rcso2, right rcso2, and rcso2 side differences for stroke, location, and types were analyzed.
Compared with stroke alert (n = 25) and overall strokes (n = 52), rcso2 and CBVI were less than those in nonstrokes (n = 133; P < .0001). Rcso2 side differences in stroke alert and overall strokes were greater than in nonstrokes (P < .0001). Lower rcso2 and CBVI correlated with both groups' stroke location, left (P < .0001) and right rcso2 (P = .004). Rcso2 differences greater than 10 had a 100% positive predictive value for stroke. Both groups' rcso2 and CBVI side differences were consistent for stroke location and type (P < .0001). For both groups, left rcso2 and CBVI were greater than those of the right (P < .0001). Hemorrhagic strokes had lower bilateral rcso2 and CBVI than did ischemic strokes (P < .001).
Cerebral oximetry and CBVI detected abnormal cerebral physiology, stroke location, and type (hemorrhagic or ischemic). Rcso2 side differences greater than 10 or rcso2 readings less than 50% had a 100% positive predictive value for stroke. Cerebral oximetry has shown potential as a detection tool for stroke location and type in a pediatric stroke alert and nonalert stroke patients. Using cerebral oximetry by the nonneurologist, we found that the patient's rcso2 side difference greater than 10 or one or both sides having less than 50% rcso2 readings suggests abnormal hemispheric pathology and expedites the patient's diagnosis, neuroresuscitation, and radiologic imaging.
尽管有儿童卒中意识和儿童卒中启动系统，但识别延迟、成像延迟以及启动不一致的情况仍然存在。需要可靠的客观儿童卒中检测工具来改善检测和启动流程。脑血氧饱和度（rcso2）与脑血容量指数（CBVI）能够检测异常的脑生理状况。
确定脑血氧测定法在检测卒中预警患者和总体卒中患者中的卒中情况。
分析了卒中患者的左侧rcso2、右侧rcso2以及rcso2的左右侧差异，包括卒中位置和类型。
与卒中预警患者（n = 25）和总体卒中患者（n = 52）相比，rcso2和CBVI低于非卒中患者（n = 133；P <.0001）。卒中预警患者和总体卒中患者的rcso2左右侧差异大于非卒中患者（P <.0001）。较低的rcso2和CBVI与两组患者的卒中位置相关，左侧（P <.0001）和右侧rcso2（P =.004）。rcso2差异大于10对卒中具有100%的阳性预测价值。两组患者的rcso2和CBVI左右侧差异在卒中位置和类型方面是一致的（P <.0001）。对于两组患者，左侧rcso2和CBVI均大于右侧（P <.0001）。出血性卒中的双侧rcso2和CBVI低于缺血性卒中（P <.001）。
脑血氧测定法和CBVI可检测异常的脑生理状况、卒中位置和类型（出血性或缺血性）。rcso2左右侧差异大于10或rcso2读数低于50%对卒中具有100%的阳性预测价值。脑血氧测定法已显示出作为检测儿童卒中预警患者和非预警卒中患者卒中位置和类型的工具的潜力。通过非神经科医生使用脑血氧测定法，我们发现患者的rcso2左右侧差异大于10或一侧或两侧rcso2读数低于50%提示半球病变异常，并可加快患者的诊断、神经复苏和放射影像学检查。
