Mackay Mark T, Churilov Leonid, Donnan Geoffrey A, Babl Franz E, Monagle Paul
From the Department of Neurology (M.T.M.), Emergency Department (F.E.B.), and Department of Haematology (P.M.), Royal Children's Hospital; Florey Institute of Neurosciences and Mental Health (L.C., G.A.D.); Murdoch Childrens Research Institute (M.T.M., F.E.B., P.M.); and University of Melbourne (M.T.M., L.C., G.A.D., F.E.B., P.M.), Parkville, Australia.
Neurology. 2016 Jun 7;86(23):2154-61. doi: 10.1212/WNL.0000000000002736. Epub 2016 May 13.
To assess the utility of the Cincinnati Prehospital Stroke Scale (CPSS) and Recognition of Stroke in the Emergency Room (ROSIER) tools in children presenting to the emergency department (ED) with brain attack symptoms.
The ROSIER and CPSS tools were retrospectively applied to 101 children with stroke, presenting from 2003 to 2010, and prospectively to 279 children with mimics, presenting from 2009 to 2010. Positive CPSS was defined as ≥1 positive sign (face/asymmetrical arm weakness, speech disturbance). Positive ROSIER was defined as a score of ≥1. Accuracy and interrater agreement between the tools and patients' true status were assessed for combined stroke types and arterial stroke (AIS) and hemorrhagic stroke (HS) subtypes vs mimics.
Stroke subtypes included AIS (55), HS (34), TIA (10), and sinovenous thrombosis (2). Mimic diagnoses included migraine (84), first seizure (45), Bell palsy (29), and conversion disorders (18). Both tools had poor reliability and accuracy for combined strokes vs mimics (CPSS κ 0.36, receiver operator characteristic curve [ROC] 0.66; ROSIER κ 0.32, ROC 0.60) and for AIS vs mimics (CPSS κ 0.37, ROC 0.79; ROSIER κ 0.30, ROC 0.77). Both tools performed inadequately for HS vs mimics (CPSS κ -0.03, ROC 0.51; ROSIER κ -0.02, ROC 0.52).
Adult stroke recognition tools perform poorly in children and require modification to be useful for pediatric stroke identification.
This study provides Class II evidence that, for children presenting to the ED with brain attack symptoms, the CPSS and ROSIER tools do not accurately distinguish strokes from mimics.
评估辛辛那提院前卒中量表（CPSS）和急诊室卒中识别（ROSIER）工具在出现脑卒中标示症状的急诊儿科患者中的应用价值。
将ROSIER和CPSS工具回顾性应用于2003年至2010年就诊的101例卒中患儿，并前瞻性应用于2009年至2010年就诊的279例症状相似的患儿。CPSS阳性定义为≥1个阳性体征（面部/不对称性手臂无力、言语障碍）。ROSIER阳性定义为得分≥1分。针对合并卒中类型、动脉性卒中（AIS）和出血性卒中（HS）亚型与症状相似疾病，评估工具与患者真实状态之间的准确性和评分者间一致性。
卒中亚型包括AIS（55例）、HS（34例）、短暂性脑缺血发作（TIA，10例）和静脉窦血栓形成（2例）。症状相似疾病诊断包括偏头痛（84例）、首次癫痫发作（45例）、贝尔麻痹（29例）和转换障碍（18例）。对于合并卒中与症状相似疾病，以及AIS与症状相似疾病，这两种工具的可靠性和准确性均较差（CPSS κ值为0.36，受试者操作特征曲线[ROC]为0.66；ROSIER κ值为0.32，ROC为0.60；CPSS κ值为0.37，ROC为0.79；ROSIER κ值为0.30，ROC为0.77）。对于HS与症状相似疾病，这两种工具的表现均不佳（CPSS κ值为 -0.03，ROC为0.51；ROSIER κ值为 -0.02，ROC为0.52）。
成人卒中识别工具在儿童中表现不佳，需要进行改进才能用于儿科卒中识别。
本研究提供II级证据，表明对于出现脑卒中标示症状的急诊儿科患者，CPSS和ROSIER工具不能准确区分卒中和症状相似疾病。
