Applying the Modified Los Angeles Prehospital Stroke Screen to a Retrospective Cohort of Children
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Abstract
Introduction: Childhood acute ischemic stroke is rare but increasingly recognized, with a variety of causes including thromboembolism, arteriopathy, prothrombotic states, systemic illness, and trauma. Childhood stroke is frequently under-recognized. Prehospital stroke scales have been widely validated in adults. The Modified Los Angeles Prehospital Stroke Screen (mLAPSS) is one tool used in the prehospital setting but not validated in children. Our goal was to determine in a retrospective cohort whether children with acute stroke had a positive mLAPSS score.
Methods: We performed a retrospective case series of patients less than 18 years old with a final diagnosis of acute ischemic stroke admitted to our pediatric hospital between 2014 and 2024. Demographics, presenting symptoms, mode of hospital arrival, hospital results and interventions, and final diagnosis were recorded. We attempted to determine mLAPSS criteria from earliest patient contact available, whether prehospital or emergency department records.
Results: Seventy patients with 82 stroke episodes were evaluated during the study period. Of those with past medical history, the most common were a cardiac defect or sickle cell disease. Median time from symptom onset to presentation was one day. Half of the patients presented by private vehicle. The most common symptom was a new focal weakness, but the majority of patients had more than one symptom. Documentation of grip strength and arm drift was uncommon. Only one patient had clear documentation of all three components of the mLAPSS. The etiology of stroke was uncertain in 27%, hypercoagulable in 23%, moyamoya or sickle cell disease in 23%, systemic disease in 15%, and cardiac disease in 12%.
Conclusion: While focal weakness, headache, and seizures were routinely documented in children with a final diagnosis of AIS, specific criteria of the mLAPSS, especially arm drift and grip strength, were rarely documented on initial examination.
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References
Arends, G., Perry, E., Sherman, A., & Flint, J. (2024). A review of an interfacility transport program pediatric stroke clinical practice guideline. Pediatric Emergency Care, 40(5), 382-385. https://doi.org/10.1097/PEC.0000000000003095
Baldovsky, M. D., & Okada, P. J. (2020). Pediatric stroke in the emergency department. Journal of the American College of Emergency Physicians Open, 1(6), 1578-1586. https://doi.org/10.1002/emp2.12275
Braun, K. P., Kappelle, L. J., Kirkham, F. J., & deVeber, G. (2006). Diagnostic pitfalls in paediatric ischaemic stroke. Developmental Medicine & Child Neurology, 48(12), 985-90. https://doi.org/10.1017/S0012162206002167
Camacho-Sampaio, M., Costa, M., Lima, C., Santos, C., Amaral, J., Palavra, F., Pereira, C., & Ribeiro, J. (2024). Arterial ischemic stroke in pediatric patients: A tertiary hospital experience. Cureus, 16(10), e72390. https://doi.org/10.7759/cureus.72390
deVeber, G. A., Kirton, A., Booth, F. A., Yager, J. Y., Wirrell, E. C., Wood, E., Shevell, M., Surmava, A. M., McCusker, P., Massicotte, M. P., MacGregor, D., MacDonald, E. A., Meaney, B., Levin, S., Lemieux, B. G., Jardine, L., Humphreys, P., David, M., Chan, A. K., ,,, Bjornson, B. H. (2017). Epidemiology and outcomes of arterial ischemic stroke in children: The Canadian pediatric ischemic stroke registry. Pediatric Neurology, 69, 58-70. https://doi.org/10.1016/j.pediatrneurol.2017.01.016
Ferriero, D. M., Fullerton, H. J., Bernard, T. J., Billinghurst, L., Daniels, S. R., DeBaun, M. R., deVeber, G., Ichord, R. N., Jordan, L. C., Massicotte, P., Meldau, J., Roach, E. S., & Smith, E. R. (2019). Management of stroke in neonates and children: A scientific statement from the American Heart Association/American Stroke Association. Stroke, 50(3), e51-e96. https://doi.org/10.1161/STR.0000000000000183
Hartman, A. L., Lunney, K. M., & Serena, J. E. (2009). Pediatric stroke: Do clinical factors predict delays in presentation? The Journal of Pediatrics, 154(5), 727-32. https://doi.org/10.1016/j.jpeds.2008.11.011
Hidalgo, M. J., Muñoz, D., Balut, F., Troncoso, M., Lara, S., Barrios, A., & Parra, P. (2018). Pediatric arterial ischemic stroke: Clinical presentation, risk factors, and pediatric NIH Stroke Scale in a series of chilean patients. Cell Medicine, 10, 2155179018760330. https://doi.org/10.1177/2155179018760330
Hollist, M., Au, K., Morgan, L., Shetty, P. A., Rane, R., Hollist, A., Amaniampong, A., & Kirmani, B. F. (2021). Pediatric stroke: Overview and recent updates. Aging and Disease, 12(4), 1043-1055. https://doi.org/10.14336/AD.2021.0219
Kidwell, C. S., Starkman, S., Eckstein, M., Weems, K., & Saver, J. L. (2000). Identifying stroke in the field. Prospective validation of the Los Angeles Prehospital Stroke Screen (LAPSS). Stroke, 31(1), 71-76. https://doi.org/10.1161/01.str.31.1.71
Lehman, L. L., Khoury, J. C., Taylor, J. M., Yeramaneni, S., Sucharew, H., Alwell, K., Moomaw, C. J., Peariso, K., Flaherty, M., Khatri, P., Broderick, J. P., Kissela, B. M., & Kleindorfer, D. O. (2018). Pediatric stroke rates over 17 years: Report from a population-based study. Journal of Child Neurology, 33(7), 463-467. https://doi.org/10.1177/0883073818767039
Mackay, M. T., Monagle, P., & Babl, F. E. (2017). Improving diagnosis of childhood arterial ischaemic stroke. Expert Review of Neurotherapeutics, 17(12), 1157-1165. https://doi.org/10.1080/14737175.2017.1395699
Mackay, M. T., Stojanovski, B., Mosley, I., Churilov, L., Donnan, G. A., & Monagle, P. (2016). Parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke. Stroke, 47(10), 2638-40. https://doi.org/10.1161/STROKEAHA.116.014728
Mackay, M. T., Wiznitzer, M., Benedict, S. L., Lee, K. J., deVeber, G. A., & Ganesan, V. (2011). Arterial ischemic stroke risk factors: The international pediatric stroke study. Annals of Neurology, 69(1), 130-40. https://doi.org/10.1002/ana.22224
Rafay, M. F., Pontigon, A. M., Chiang, J., Adams, M., Jarvis, D. A., Silver, F., Macgregor, D., deVeber, G. A. (2009). Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke, 40(1), 58-64. https://doi.org/10.1161/STROKEAHA.108.519066
Söbü, E., Özdemir, N., Uysal, S., Buyru, N., & Celkan, T. (2019). Pediatric stroke: A single-center experience. Journal of Pediatric Hematology/Oncology, 41(7), 519-524. https://doi.org/10.1097/MPH.0000000000001539
Turón-Viñas, E., Boronat, S., Gich, I., González Álvarez, V., García-Puig, M., Camós Carreras, M., Rodriguez-Palmero, A., Felipe-Rucián, A., Aznar-Laín, G., Jiménez-Fàbrega, X., & Pérez de la Ossa, N. (2024). Design and interrater reliability of the pediatric version of the RACE scale: PedRACE. Stroke, 55(9), 2240-2246. https://doi.org/10.1161/STROKEAHA.124.046846
Yock-Corrales, A., Varela-Bulgarelli, F., Barboza, C., Gutierrez-Mata, A., Mackay, M. T., & Babl, F. (2018). Presentation of acute childhood stroke in a tertiary pediatric emergency department. Pediatric Emergency Care, 34(8), 552-557. https://doi.org/10.1097/PEC.0000000000000918