Development and Validation of a Postprocedure Stroke Screening Tool in Children With Cardiac Disease

Authors

Dana B. Harrar, Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
Catherine L. Salussolia, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Louisa G. Keith, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Shangyuan Ye, Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Julie S. Meadows, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Alexandra Fialkow, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Guangyu Zhu, Department of Computer Science and Statistics, University of Rhode Island, Kingston, RI, USA.
Christina VanderPluym, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Bo Zhang, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Michael J. Rivkin, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Document Type

Journal Article

Publication Date

1-12-2025

Journal

Journal of child neurology

DOI

10.1177/08830738241302511

Keywords

arterial ischemic stroke; cardiac catherization; congenital heart disease; stroke screen

Abstract

BACKGROUND: Cardiac catheterization in children with heart disease is associated with an increased risk of arterial ischemic stroke. We created and evaluated the diagnostic performance of a bedside screening tool administered postprocedure to identify arterial ischemic stroke. METHODS: We developed a postprocedure stroke screen comprising history of stroke, responsiveness, command following, speech, facial and limb strength symmetry, new seizure, and caregiver concern. We compared the performance of the screening tool in a retrospective cohort of 21 patients with a postcatheterization arterial ischemic stroke and a prospective cohort of 100 consecutive control patients after cardiac catheterization. RESULTS: The postprocedure stroke screen delivered a maximum Youden index ranging from 0.810 to 0.937 at threshold scores of 2 or 2.5 and gave a sensitivity and specificity >0.9. The area under the receiver operating characteristic curve ranged from 0.931 to 0.946. CONCLUSIONS: We developed a screening tool with high sensitivity and specificity to identify postcatheterization arterial ischemic stroke in children.

APA Citation

Harrar, Dana B.; Salussolia, Catherine L.; Keith, Louisa G.; Ye, Shangyuan; Meadows, Julie S.; Fialkow, Alexandra; Zhu, Guangyu; VanderPluym, Christina; Zhang, Bo; and Rivkin, Michael J., "Development and Validation of a Postprocedure Stroke Screening Tool in Children With Cardiac Disease" (2025). GW Authored Works. Paper 6374.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6374

Department

Neurology