Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Pediatr Res. 2020 Aug;88(2):234-242. doi: 10.1038/s41390-020-0842-5. Epub 2020 Mar 16.
The pediatric stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM.
We identified 367 neonates/children with arterial ischemic stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n = 97) scored; and (b) an external cohort (AIS; n = 102) with concurrently scored modified Rankin Scale (mRS), King's Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM.
Within the Derivation Cohort, LCA identified three severity levels: "normal/mild," "moderate," and "severe" (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: "normal/mild"-normal function in all domains or slowing in one domain, "moderate"-slowing in ≥2 domains or missing function in one domain, and "severe"-missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79).
The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in pediatric stroke.
Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate.The prior severity classification using PSOM overestimates poor outcomes.Three distinct severity profiles using PSOM subscales are identified.The PSOM-SCS is in moderate to excellent agreement with other disability measures.PSOM-SCS offers a valid tool for classifying the overall neurological deficit severity.
儿科中风结局测量工具（PSOM）是一种标准化的、针对特定疾病的结局测量工具。我们旨在验证 PSOM 用于评估神经功能缺损严重程度的总体分类。
我们纳入 367 例动脉缺血性卒中（AIS）新生儿/儿童（推导队列）。我们使用潜在类别分析（LCA）对 PSOM 子量表（评分 0 [无缺损]、0.5 [轻度/轻微缺损；正常功能]、1 [中度缺损；减慢功能]或 2 [重度缺损；缺失功能]）进行分析，以确定严重程度级别。我们在以下情况中验证了严重程度分类方案（PSOM-SCS）：（a）有儿科残疾评估量表（PEDI；n=63）和/或儿科生活质量量表（PedsQL；n=97）评分的儿童；以及（b）有同时评分的改良 Rankin 量表（mRS）、King 儿童头伤结局量表（KOSCHI）和 PSOM 的外部队列（AIS；n=102）。
在推导队列中，LCA 确定了三个严重程度级别：“正常/轻度”（83.7%）、“中度”（13.3%）和“重度”（3%）。我们根据 PSOM 子量表评分制定了严重程度分类：“正常/轻度”-所有领域的正常功能或一个领域的减慢功能，“中度”-≥2 个领域的减慢功能或一个领域的缺失功能，以及“重度”-≥2 个领域的缺失功能或≥1 个领域的减慢功能加缺失功能。PEDI 和 PedsQL 在严重程度组间均有显著差异。PSOM-SCS 与 mRS（一致性系数[AC2] = 0.88）和 KOSCHI（AC2 = 0.79）高度一致。
PSOM-SCS 是一种有效的工具，用于分类强调功能且涵盖儿科中风全范围严重程度的总体神经功能缺损严重程度。
对 PSOM 子量表评分进行算术求和以评估严重程度分类是不充分的。使用 PSOM 进行的先前严重程度分类高估了不良结局。使用 PSOM 子量表确定了三个不同的严重程度特征。PSOM-SCS 与其他残疾测量工具具有中度至极好的一致性。PSOM-SCS 为分类整体神经功能缺损严重程度提供了有效的工具。
