Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children with Acute Ischemic Stroke

Lauren A. Beslow, Arastoo Vossough, Rebecca N. Ichord, Nedelina Slavova, Maggie L.Y. Yau, Jay Gajera, Belinda Stojanovski, Malik M. Adil, Jake Breimann, Alexandra Kimmel, Mark T. MacKay

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Objectives We aimed to determine whether a modified pediatric Alberta Stroke Program Early CT Score (modASPECTS) is associated with clinical stroke severity, hemorrhagic transformation, and 12-month functional outcomes in children with acute arterial ischemic stroke (AIS). Methods Children (age 29 days-<18 years) with acute AIS enrolled in 2 institutional prospective stroke registries at the Children's Hospital of Philadelphia and Royal Children's Hospital Melbourne, Australia were retrospectively analyzed to determine whether modASPECTS, in which higher scores are worse, correlated with acute pediatric NIH Stroke Scale (PedNIHSS) scores (children ≥2 years of age), was associated with hemorrhagic transformation on acute MRI, and correlated with 12-month functional outcome on the Pediatric Stroke Outcome Measure. Results One hundred thirty-one children were included; 91 were ≥2 years of age. Median time from stroke toMRI was 1 day (interquartile range [IQR] 0-1 day). Median modASPECTS was 4 (IQR 3-7). ModASPECTS correlated with PedNIHSS score (ρ = 0.40, p = 0.0001). ModASPECTS was associated with hemorrhagic transformation (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25, p = 0.018). Among children with follow-up (n = 128, median 12.2 months, IQR 9.5-15.4 months), worse outcomes were associated with higher modASPECTS (common OR 1.14, 95% CI 1.04-1.24, p = 0.005). The association between modASPECTS and outcome persisted when we adjusted for age at stroke ictus and the presence of tumor or meningitis as stroke risk factors (common OR 1.14, 95% CI 1.03-1.25, p = 0.008). Discussion ModASPECTS correlates with PedNIHSS scores, hemorrhagic transformation, and 12-month functional outcome in children with acute AIS. Future pediatric studies should evaluate its usefulness in predicting symptomatic intracranial hemorrhage and outcome after acute revascularization therapies.

Original languageEnglish (US)
Pages (from-to)E1202-E1209
JournalNeurology
Volume97
Issue number12
DOIs
StatePublished - 2021

ASJC Scopus subject areas

  • Clinical Neurology

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