Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children With Acute Ischemic Stroke

Lauren A Beslow; Arastoo Vossough; Rebecca N Ichord; Nedelina Slavova; Maggie L Y Yau; Jay Gajera; Belinda Stojanovski; Malik M Adil; Jake Breimann; Alexandra Kimmel; Mark T Mackay

doi:10.1212/WNL.0000000000012558

Association of Pediatric ASPECTS and NIH Stroke Scale, Hemorrhagic Transformation, and 12-Month Outcome in Children With Acute Ischemic Stroke

Neurology. 2021 Sep 20;97(12):e1202-e1209. doi: 10.1212/WNL.0000000000012558.

Affiliations

¹ From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia. beslow@chop.edu.
² From the Departments of Neurology (L.A.B., R.N.I., J.B., A.K.), Pediatrics (L.A.B., R.N.I., J.B., A.K.), and Radiology (A.V.), Perelman School of Medicine at the University of Pennsylvania; Divisions of Neurology (L.A.B., R.N.I., J.B., A.K.) and Neuroradiology (A.V.), Children's Hospital of Philadelphia, PA; Department of Diagnostic, Interventional and Pediatric Radiology (N.S.), Inselspital, Bern University Hospital, Switzerland; Department of Pediatrics (M.L.Y.Y.), Prince of Wales Hospital; Department of Pediatrics (M.L.Y.Y.), The Chinese University of Hong Kong; Department of Surgery (J.G.), The Alfred Hospital Melbourne; Department of Neurology (B.S., M.T.M.), Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neurology (M.M.A.), Johns Hopkins University School of Medicine, Baltimore, MD; Murdoch Children's Research Institute (M.T.M.); and Department of Pediatrics (M.T.M.), University of Melbourne, Victoria, Australia.

PMID: 34389646
DOI: 10.1212/WNL.0000000000012558

Abstract

Background and objectives: We aimed to determine whether a modified pediatric Alberta Stroke Program Early CT Score (modASPECTS) is associated with clinical stroke severity, hemorrhagic transformation, and 12-month functional outcomes in children with acute arterial ischemic stroke (AIS).

Methods: Children (age 29 days-<18 years) with acute AIS enrolled in 2 institutional prospective stroke registries at the Children's Hospital of Philadelphia and Royal Children's Hospital Melbourne, Australia were retrospectively analyzed to determine whether modASPECTS, in which higher scores are worse, correlated with acute pediatric NIH Stroke Scale (PedNIHSS) scores (children ≥2 years of age), was associated with hemorrhagic transformation on acute MRI, and correlated with 12-month functional outcome on the Pediatric Stroke Outcome Measure.

Results: One hundred thirty-one children were included; 91 were ≥2 years of age. Median time from stroke to MRI was 1 day (interquartile range [IQR] 0-1 day). Median modASPECTS was 4 (IQR 3-7). ModASPECTS correlated with PedNIHSS score (ρ = 0.40, p = 0.0001). ModASPECTS was associated with hemorrhagic transformation (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02-1.25, p = 0.018). Among children with follow-up (n = 128, median 12.2 months, IQR 9.5-15.4 months), worse outcomes were associated with higher modASPECTS (common OR 1.14, 95% CI 1.04-1.24, p = 0.005). The association between modASPECTS and outcome persisted when we adjusted for age at stroke ictus and the presence of tumor or meningitis as stroke risk factors (common OR 1.14, 95% CI 1.03-1.25, p = 0.008).

Discussion: ModASPECTS correlates with PedNIHSS scores, hemorrhagic transformation, and 12-month functional outcome in children with acute AIS. Future pediatric studies should evaluate its usefulness in predicting symptomatic intracranial hemorrhage and outcome after acute revascularization therapies.

Classification of evidence: This study provides Class II evidence that the modASPECTS on MRI is associated with stroke severity (as measured by the baseline PedNIHSS score), hemorrhagic transformation, and 12-month outcome in children with acute supratentorial ischemic stroke.