Clinical Trial Validates First Pediatric Stroke Severity Scale


LOS ANGELES – For the first time, a pediatric stroke severity scale has been validated in a prospective clinical trial.

The study in 15 North American medical centers showed excellent interrater reliability when neurologists used a pediatric version of the National Institutes of Health Stroke Scale for adults to examine children aged 2–18 years with acute arterial ischemic stroke.

The neurologists used the Pediatric NIH Stroke Scale (PedNIHSS) on 113 patients examined daily from admission to discharge, or through day 7 of hospitalization. Interrater reliability was tested in a subset of 25 patients who were examined simultaneously by two pediatric neurologists. Characteristics of the subgroup were similar to those of the entire cohort, Dr. Rebecca N. Ichord reported.

The simultaneous raters' scores were identical in 60% of ratings and were within a 1-point difference in 84% of ratings (Stroke 2011;42:613–7).

Research into potential ways of preventing or treating childhood stroke has been stymied in the past by the lack of a validated and reliable pediatric stroke scale. The PedNIHSS provides a way to index the severity of a child's stroke, to make comparisons across treatment groups, and to get a baseline for predicting outcome, said Dr. Ichord, director of the pediatric stroke program at the Children's Hospital of Philadelphia.

Clinicians, too, have been hungering for such a scale. “I have been asked over and over again [for a pediatric stroke scale] by clinicians who want to have a method of describing the severity of a child's stroke,” she said at the meeting, which was sponsored by the American Heart Association. “It's absolutely needed and wanted right now by clinicians on the front line.”

Characteristics of the patients and the strokes in the study were similar to those reported in previous pediatric stroke cohort studies, which suggests the current findings are generalizable and the PedNIHSS should be applicable in other settings.

The PedNIHSS was drafted by a consensus panel of pediatric and adult stroke experts. Dr. Ichord and one of her associates in the study are on the clinical event committee for the Berlin Heart Trial for pediatric ventricular assist devices.

A pediatric stroke scale is 'absolutely needed and wanted right now by clinicians on the front line.'


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