Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR
Correspondence
Corresponding author at: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, 1 Children's Way, Slot, Little Rock, AR 72223. Tel.: +1 501 364 2299; fax: +1 615 343 8407.
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR
Correspondence
Corresponding author at: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, 1 Children's Way, Slot, Little Rock, AR 72223. Tel.: +1 501 364 2299; fax: +1 615 343 8407.
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR
Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR
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Figures
Fig. 1
Left and right rcso2 and CBVI trends for 40 minutes for the stroke alert and overall stroke groups.
Fig. 2
Left and right cerebral rcso2 and CBVI graph for individual hemorrhagic and ischemic stroke patient.
Fig. 3
Left rcso2, right rcso2, difference between rcso2 sides, and ROC curve time interval every 5 seconds, from 0 to 10 minutes for stroke alert, overall stroke, and overall stroke patients without 4 hemorrhagic outliers with side differences of 3.1 but left and right rcso2 sides less than 49% rcso2 reading.
Abstract
Background
Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rcso2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology.
Objective
To determine cerebral oximetry in detecting strokes in stroke alert and overall stroke patients.
Method
Left rcso2, right rcso2, and rcso2 side differences for stroke, location, and types were analyzed.
Results
Compared with stroke alert (n = 25) and overall strokes (n = 52), rcso2 and CBVI were less than those in nonstrokes (n = 133; P < .0001). Rcso2 side differences in stroke alert and overall strokes were greater than in nonstrokes (P < .0001). Lower rcso2 and CBVI correlated with both groups' stroke location, left (P < .0001) and right rcso2 (P = .004). Rcso2 differences greater than 10 had a 100% positive predictive value for stroke. Both groups' rcso2 and CBVI side differences were consistent for stroke location and type (P < .0001). For both groups, left rcso2 and CBVI were greater than those of the right (P < .0001). Hemorrhagic strokes had lower bilateral rcso2 and CBVI than did ischemic strokes (P < .001).
Conclusions
Cerebral oximetry and CBVI detected abnormal cerebral physiology, stroke location, and type (hemorrhagic or ischemic). Rcso2 side differences greater than 10 or rcso2 readings less than 50% had a 100% positive predictive value for stroke. Cerebral oximetry has shown potential as a detection tool for stroke location and type in a pediatric stroke alert and nonalert stroke patients. Using cerebral oximetry by the nonneurologist, we found that the patient's rcso2 side difference greater than 10 or one or both sides having less than 50% rcso2 readings suggests abnormal hemispheric pathology and expedites the patient's diagnosis, neuroresuscitation, and radiologic imaging.
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☆Study presented as abstract: (1) International Stroke AHA Conference 2015 (poster), Nashville, TN, and (2) Pediatric Academic Society meeting 2015 (oral presentation).
☆☆Conflict of interest statement: There was no financial assistance or support, or sponsorship by any of the companies mentioned. The authors alone are responsible for the content and writing of this manuscript.
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