Stroke is an important cause of death and disability among children, for whom there is no proven therapy except blood transfusion for sickle cell anemia. Research leading to improved treatment of stroke has largely excluded children. Progress in understanding pathophysiology and improved treatment of childhood stroke requires multicenter prospective cohort studies to define reliable and valid outcome predictors. Determinants of outcome in childhood stroke are unknown. Clinical stroke severity measured by the NIH Stroke Scale (NIHSS) is a robust outcome predictor in adults, but has not been studied in children. The purpose of this project is to evaluate the reliability, validity and predictive utility of a pediatric adaptation of the NIHSS, (PedNIHSS). There are three specific aims, to assess: 1) the relationship of PedNIHSS to acute infarct volume and location measured on brain MRI; 2) predictive utility of PedNIHSS score relative to 3- and 12-month neurologic and functional outcomes; 3) inter-rater reliability and predictive sensitivity and specificity of the PedNIHSS. In a consecutive prospective cohort study, 8 pediatric tertiary care hospitals in the International Pediatric Stroke Study network will enroll 120 subjects over 18 months, to include all children age 2-18 years with acute arterial ischemic stroke, excluding patients with acute head injury, cardiac arrest, brain tumor or meningitis. PedNIHSS will be recorded daily for 7 days, and correlated with infarct volume on T2-weighted MRI obtained on admission and at 5-7 days after symptom onset. Predictive utility of PedNIHSS will be assessed by multivariate regression models for 3- and 12-month outcomes which will include measures of neurologic impairment using the Pediatric Stroke Outcome Measure, disability using the Pediatric Evaluation of Disability Inventory, and quality of life using the PedsQL. Interrater reliability will be measured by comparing PedNIHSS scores given by a primary examiner with that of a second examiner observing the examination. The results of this study will provide new information about how initial clinical stroke severity is related to size and location of the stroke, its importance in predicting outcome in children, and the influence of age, gender, and stroke risk factor on the prediction of outcome. These observations, and the availability of a simple valid clinical stroke scale for children, will be important for planning and conducting future clinical trials and outcome studies for childhood stroke. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS050488-01A1
Application #
7034260
Study Section
Developmental Brain Disorders Study Section (DBD)
Program Officer
Hirtz, Deborah G
Project Start
2006-09-01
Project End
2009-08-31
Budget Start
2006-09-01
Budget End
2007-08-31
Support Year
1
Fiscal Year
2006
Total Cost
$500,448
Indirect Cost
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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Bernard, Timothy J; Beslow, Lauren A; Manco-Johnson, Marilyn J et al. (2016) Inter-Rater Reliability of the CASCADE Criteria: Challenges in Classifying Arteriopathies. Stroke 47:2443-9
Plumb, Patricia; Seiber, Eric; Dowling, Michael M et al. (2015) Out-of-pocket costs for childhood stroke: the impact of chronic illness on parents' pocketbooks. Pediatr Neurol 52:73-6.e2
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Lin, Kimberly Y; Kerur, Basavaraj; Witmer, Char M et al. (2014) Thrombotic events in critically ill children with myocarditis. Cardiol Young 24:840-7
Beslow, Lauren A; Ichord, Rebecca N; Gindville, Melissa C et al. (2014) Pediatric intracerebral hemorrhage score: a simple grading scale for intracerebral hemorrhage in children. Stroke 45:66-70
Beslow, Lauren A; Abend, Nicholas S; Gindville, Melissa C et al. (2013) Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy. JAMA Neurol 70:448-54
Bernard, Timothy J; Manco-Johnson, Marilyn J; Lo, Warren et al. (2012) Towards a consensus-based classification of childhood arterial ischemic stroke. Stroke 43:371-7
Beslow, Lauren A; Kasner, Scott E; Smith, Sabrina E et al. (2012) Concurrent validity and reliability of retrospective scoring of the Pediatric National Institutes of Health Stroke Scale. Stroke 43:341-5

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