Stroke score modified for pediatric patients correlates with severity, other outcomes

The modified pediatric Alberta Stroke Program Early CT Score correlated with stroke severity, hemorrhagic transformation and 1-year outcomes among children with supratentorial ischemic stroke, according to findings published in Neurology.

“The Alberta Stroke Program Early CT Score (ASPECTS) assesses early ischemic changes in adult middle cerebral artery infarction and predicts 3-month functional outcome after thrombolytic therapy. A modified pediatric ASPECTS (modASPECTS) correlates with infarct volume,” the researchers wrote.

“ModASPECTS is performed on diffusion-weighted imaging (DWI), includes anterior and posterior cerebral artery regions, and higher scores indicate more areas of infarction,” they continued. “ModASPECTS predicts epilepsy, cerebral palsy and neurological impairment after perinatal arterial ischemic stroke (AIS) and functional outcome in children with AIS due to focal cerebral arteriopathy.”

However, the link between modASPECTS and outcomes in a broader group of children with AIS and various risk factors has not been examined, according to the researchers. Lauren A. Beslow, MD MSCE, FAHA, attending physician in the division of neurology at Children’s Hospital of Philadelphia, and colleagues aimed to determine whether modASPECTS could be used as a determinant of eligibility for hyperacute therapies.

The researchers retrospectively analyzed children aged 29 days to less than 18 years with AIS who were enrolled in two institutional prospective stroke registries at Children’s Hospital of Philadelphia and Royal Children’s Hospital Melbourne in Australia. They examined whether modASPECTS, in which higher scores are worse, correlated with acute Pediatric NIH Stroke Scale (PedNIHSS) scores in children aged 2 years or older; was related to hemorrhagic transformation on acute MRI; and correlated with 12-month functional outcome on the Pediatric Stroke Outcome Measure (PSOM).

Beslow and colleagues included 131 children in the study, more than half of whom (n = 91) were aged 2 years or older. The median number of days from stroke to MRI was 1, and the median modASPECTS score was 4.

The investigators found that modASPECTS was associated with PedNIHSS (P = .0001) and hemorrhagic transformation (OR 1.13; 95% CI, 1.02-1.25).

Among children with follow-up (n = 128, median follow-up period, 12.2 months), Beslow and colleagues reported that poorer outcomes correlated with higher modASPECTS (common OR = 1.14; 95% CI, 1.04-1.24). The relationship between modASPECTS and outcome remained when the researchers adjusted for age at stroke and the presence of tumor or meningitis as risk factors for stroke, according to the study results (common OR = 1.14; 95% CI, 1.03-1.25).

Beslow and colleagues wrote that the results of the present study provide class II evidence that modASPECTS on MRI correlated with stroke severity, as determined by the baseline PedNIHSS, as well as hemorrhagic transformation and 12-month outcomes among children with acute supratentorial ischemic stroke.

“Future pediatric studies should evaluate its usefulness in predicting symptomatic intracranial hemorrhage and outcome after acute revascularization therapies,” the investigators wrote.