1
|
Lo D, Waite M, Rose TA. Looking beyond body structure and function: a scoping review of non-impairment impacts of stroke on adolescents. Brain Inj 2024:1-14. [PMID: 39277841 DOI: 10.1080/02699052.2024.2390858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/18/2024] [Accepted: 08/06/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Much of the childhood stroke literature has not distinguished impacts for adolescents from those of younger children. Research has also focused on body impairments. With adolescence being a unique period, this scoping review aimed to identify the impacts of childhood stroke on activity, participation, and quality of life for adolescents 13-18 years, and identify how these impacts were determined. METHOD This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Data pertaining to non-impairment impacts of childhood stroke for adolescents, participant and study characteristics, and measurement instruments were extracted. RESULTS Following screening, 79 articles were included, and 33 measurement instruments identified. Only 6 studies reported separate data for adolescents, identifying difficulties with daily activities, social and academic impacts, and reduced quality of life. Impacts of post-stroke communication difficulties on daily activities and schooling were also noted. Measurement instruments developed specifically for adolescents with stroke are lacking. INTERPRETATION The review identified limited research reporting non-impairment impacts of childhood stroke for adolescents. Further research specific to this population and the development of measurement instruments for adolescents who have experienced childhood stroke is required to support future research and clinicians working with this population.
Collapse
Affiliation(s)
- Davina Lo
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Monique Waite
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Rodwin RL, Wang F, Lu L, Li Z, Srivastava DK, Phillips NS, Khan RB, Brinkman TM, Krull KR, Boop FA, Armstrong GT, Merchant TE, Gajjar A, Robison LL, Hudson MM, Kadan‐Lottick NS, Ness KK. Motor and sensory impairment in survivors of childhood central nervous system (CNS) tumors in the St. Jude Lifetime Cohort (SJLIFE). Cancer Med 2024; 13:e7422. [PMID: 39056576 PMCID: PMC11273544 DOI: 10.1002/cam4.7422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Survivors of childhood central nervous system (CNS) tumors can develop motor and sensory impairment from their cancer and treatment history. We estimated the prevalence of motor and sensory impairment in survivors compared with controls through clinical assessment and identified associated treatment exposures and functional, quality of life (QOL), and social outcomes. METHODS Survivors of childhood CNS tumors from the St. Jude Lifetime Cohort (n = 378, median [range] age 24.0 [18.0-53.0] years, 43.4% female) ≥5 years from diagnosis and controls (n = 445, median [range] age 34.0 [18.0-70.0] years, 55.7% female) completed in-person evaluation for motor and sensory impairment using the modified Total Neuropathy Score. Impairment was graded by modified Common Terminology Criteria for Adverse Events. Multivariable models estimated associations between grade ≥2 motor/sensory impairment, individual/treatment characteristics, and secondary outcomes (function by Physical Performance Test, fitness by physiologic cost index, QOL by Medical Outcomes Survey Short Form-36 physical/mental summary scores, social attainment). RESULTS Grade ≥2 motor or sensory impairment was more prevalent in survivors (24.1%, 95% Confidence Interval [CI] 19.8%-29.4%) than controls (2.9%, CI 1.4-4.5%). Among survivors, in multivariable models, motor impairment was associated with vinca exposure <15 mg/m2 versus none (OR 4.38, CI 1.06-18.08) and etoposide exposure >2036 mg/m2 versus none (OR 12.61, CI 2.19-72.72). Sensory impairment was associated with older age at diagnosis (OR 1.09, CI 1.01-1.16) and craniospinal irradiation versus none (OR 4.39, CI 1.68-11.50). There were lower odds of motor/sensory impairment in survivors treated in the year 2000 or later versus before 1990 (Motor: OR 0.29, CI 0.10-0.84, Sensory: OR 0.35, CI 0.13-0.96). Motor impairment was associated with impaired physical QOL (OR 2.64, CI 1.22-5.72). CONCLUSIONS In survivors of childhood CNS tumors, motor and sensory impairment is prevalent by clinical assessment, especially after exposure to etoposide, vinca, or craniospinal radiation. Treating motor impairment may improve survivors' QOL.
Collapse
Affiliation(s)
- Rozalyn L. Rodwin
- Department of PediatricsYale University School of MedicineNew HavenConnecticutUSA
- Yale Cancer CenterNew HavenConnecticutUSA
| | - Fang Wang
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lu Lu
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Zhenghong Li
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Deo Kumar Srivastava
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nicholas S. Phillips
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Raja B. Khan
- Department of PediatricsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology and Behavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Kevin R. Krull
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Psychology and Behavioral SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Frederick A. Boop
- Department of SurgerySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Thomas E. Merchant
- Department of Radiological SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Amar Gajjar
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Nina S. Kadan‐Lottick
- Cancer Prevention and Control ProgramGeorgetown Lombardi Comprehensive Cancer CenterWashingtonDCUSA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTennesseeUSA
| |
Collapse
|
3
|
Camilleri C, Wilson A, Beribisky N, Desrocher M, Williams T, Dlamini N, Westmacott R. Social skill and social withdrawal outcomes in children following pediatric stroke. Child Neuropsychol 2024:1-17. [PMID: 38557290 DOI: 10.1080/09297049.2024.2335107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children's social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke. Children with ischemic stroke demonstrated elevated parent-reported social skills problems (observed = 20.51%, expected = 14.00%) and clinically elevated social withdrawal (observed = 11.21%, expected = 2.00%). Attentional problems significantly contributed to reduced social skills, F (3,164) = 30.68, p < 0.01, while attentional problems and neurological impairments accounted for increased withdrawal behavior, F (2, 164) = 7.47, p < 0.01. The presence of a motor impairment was associated with higher social withdrawal compared to individuals with no motor impairment diagnosis, t(307.73) = 2.25, p < .025, d = 0.25, 95% CI [0.42, 6.21]. The current study demonstrates that children with stroke who experience motor impairments, attentional problems, reduced functional communication skills, and neurological impairments can experience deficits in their social skills and withdrawal behavior.
Collapse
Affiliation(s)
| | - Alyssia Wilson
- Department of Psychology, York University, Toronto, Canada
| | | | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
| | - Tricia Williams
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nomazulu Dlamini
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Rivella C, Zanetti A, Bertamino M, Primavera L, Moretti P, Viterbori P. Emotional and social functioning after stroke in childhood: a systematic review. Disabil Rehabil 2023; 45:4175-4189. [PMID: 36384380 DOI: 10.1080/09638288.2022.2144490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood. METHODS A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria. RESULTS The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment. CONCLUSIONS The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.
Collapse
Affiliation(s)
- Carlotta Rivella
- Department of Educational Science, University of Genoa, Genoa, Italy
| | - Alice Zanetti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marta Bertamino
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Paolo Moretti
- Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paola Viterbori
- Department of Educational Science, University of Genoa, Genoa, Italy
| |
Collapse
|
5
|
Sletvold TP, Boland S, Schipmann S, Mahesparan R. Quality indicators for evaluating the 30-day postoperative outcome in pediatric brain tumor surgery: a 10-year single-center study and systematic review of the literature. J Neurosurg Pediatr 2023; 31:109-123. [PMID: 36401544 DOI: 10.3171/2022.10.peds22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Surgery is the cornerstone in the management of pediatric brain tumors. To provide safe and effective health services, quantifying and evaluating quality of care are important. To do this, there is a need for universal measures in the form of indicators reflecting quality of the delivered care. The objective of this study was to analyze currently applied quality indicators in pediatric brain tumor surgery and identify factors associated with poor outcome at a tertiary neurosurgical referral center in western Norway. METHODS All patients younger than 18 years of age who underwent surgery for an intracranial tumor at the Department of Neurosurgery at Haukeland University Hospital in Bergen, Norway, between 2009 and 2020 were included. The primary outcomes of interest were classic quality indicators: 30-day readmission, 30-day reoperation, 30-day mortality, 30-day nosocomial infection, and 30-day surgical site infection (SSI) rates; and length of stay. The secondary aim was the identification of risk factors related to unfavorable outcome. The authors also conducted a systematic literature review. Articles concerning pediatric brain tumor surgery reporting at least two quality indicators were of interest. RESULTS The authors included 82 patients aged 0-17 years. The 30-day outcomes for unplanned reoperation, unplanned remission, mortality, nosocomial infection, and SSI were 9.8%, 14.6%, 0%, 6.1%, and 3.7%, respectively. Unplanned reoperation was associated with eloquent localization (p = 0.009), primary emergency surgery (p = 0.003), and CSF diversion procedures (p = 0.002). Greater tumor volume was associated with unplanned readmission (p = 0.008), nosocomial infection (p = 0.004), and CSF leakage (p = 0.005). In the systematic review, after full-text screening, 16 articles were included and provided outcome data for 1856 procedures. Overall, the 30-day mortality rate was low, varying from 0% to 9.3%. The 30-day reoperation rate varied from 1.5% to 12%. The SSI rate ranged between 0% and 3.9%, and 0% to 17.4% of patients developed CSF leakage. Four studies reported infratentorial tumor location as a risk factor for postoperative CSF leakage. CONCLUSIONS The 30-day outcomes in the authors' department were comparable to published outcomes. The most relevant factors related to unfavorable outcomes are tumor volume and location, both of which are not modifiable by the surgeon. This highlights the importance of risk adjustment. This evaluation of quality indicators reveals concerns related to the unclear and nonstandardized definitions of outcomes. Standardized outcome definitions and documentation in a large and multicentric database are needed in the future for further evaluation of quality indicators.
Collapse
Affiliation(s)
| | - Solveig Boland
- 1Department of Clinical Medicine, University of Bergen; and
| | | | - Rupavatana Mahesparan
- 1Department of Clinical Medicine, University of Bergen; and
- 2Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
6
|
Slim M, Fox CK, Friefeld S, Dlamini N, Westmacott R, Moharir M, MacGregor D, deVeber G. Validation of the pediatric stroke outcome measure for classifying overall neurological deficit. Pediatr Res 2020; 88:234-242. [PMID: 32179868 DOI: 10.1038/s41390-020-0842-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/06/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pediatric stroke outcome measure (PSOM) is a standardized, disease-specific outcome measure. We aimed to validate the overall classification of neurological deficit severity using PSOM. METHODS We identified 367 neonates/children with arterial ischemic stroke (AIS) (Derivation Cohort). We analyzed the PSOM subscales (scored as 0 [no deficit], 0.5 [minimal/mild deficit; normal function], 1 [moderate deficit; slowing function], or 2 [severe deficit; missing function]) to derive severity levels using latent class analysis (LCA). We validated a severity classification scheme (PSOM-SCS) in: (a) children who had Pediatric Evaluation of Disability Inventory (PEDI; n = 63) and/or the Pediatric Quality-of-Life Inventory (PedsQL; n = 97) scored; and (b) an external cohort (AIS; n = 102) with concurrently scored modified Rankin Scale (mRS), King's Outcome Scale for Childhood Head-Injury (KOSCHI) and PSOM. RESULTS Within the Derivation Cohort, LCA identified three severity levels: "normal/mild," "moderate," and "severe" (83.7%, 13.3%, and 3%, respectively). We developed severity classification based on PSOM subscale scores: "normal/mild"-normal function in all domains or slowing in one domain, "moderate"-slowing in ≥2 domains or missing function in one domain, and "severe"-missing function in ≥2 domains or slowing in ≥1 plus missing in one domain. PEDI and PedsQL both differed significantly across the severity groups. PSOM-SCS displayed high concordance with mRS (agreement coefficient [AC2] = 0.88) and KOSCHI (AC2 = 0.79). CONCLUSION The PSOM-SCS constitutes a valid tool for classifying overall neurological severity emphasizing function and encompassing the full range of severity in pediatric stroke. IMPACT Arithmetic summing of the PSOM subscales scores to assess severity classification is inadequate.The prior severity classification using PSOM overestimates poor outcomes.Three distinct severity profiles using PSOM subscales are identified.The PSOM-SCS is in moderate to excellent agreement with other disability measures.PSOM-SCS offers a valid tool for classifying the overall neurological deficit severity.
Collapse
Affiliation(s)
- Mahmoud Slim
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christine K Fox
- Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sharon Friefeld
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahendranath Moharir
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune MacGregor
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle deVeber
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
| | | |
Collapse
|
7
|
Champigny CM, Deotto A, Westmacott R, Dlamini N, Desrocher M. Academic outcome in pediatric ischemic stroke. Child Neuropsychol 2020; 26:817-833. [DOI: 10.1080/09297049.2020.1712346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Angela Deotto
- Department of Psychology, York University, Toronto, Canada
| | - Robyn Westmacott
- Department of Psychology, the Hospital for Sick Children, Toronto, Canada
| | - Nomazulu Dlamini
- Division of Neurology, the Hospital for Sick Children, Toronto, Canada
| | - Mary Desrocher
- Department of Psychology, York University, Toronto, Canada
- SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| |
Collapse
|
8
|
Abstract
The aim of this study was to evaluate the clinical characteristics, risk factors, treatment, and outcomes of pediatric stroke cases. A total of 118 patients diagnosed with arterial ischemic stroke (AIS), hemorrhagic stroke, and sinovenous thrombosis (SVT) between January 2000 and December 2011 were included. Neonatal cases were excluded. Demographic and clinical findings were retrospectively examined from medical records. We identified 118 patients with stroke. The age of the patients ranged from 1 to 215 months (17.92 y), with a mean age of 5.19±5.25 years. AIS accounted for the majority of cases (n=69, 58.5%), and the major etiology was cardiac disease (17%). Hemorrhagic stroke accounted for 19.5% (n=23) of the cases, and late hemorrhagic disease of the newborn was the major etiology (43%, n=10). SVT accounted for 22% (n=26) of the cases, and the major etiology was otitis media-mastoiditis (27%, n=7). Hemiplegia and headache were the most frequent symptoms for AIS and SVT, respectively. Stroke is rare in children compared with adults; however, it is detected more frequently with better imaging techniques and increased awareness. We found that children with AIS presented more commonly with hemiplegia and children with SVT with headache and strabismus. We did not find an association between thrombophilia and stroke.
Collapse
|
9
|
Health related quality of life and manual ability 5 years after neonatal ischemic stroke. Eur J Paediatr Neurol 2019; 23:716-722. [PMID: 31473077 DOI: 10.1016/j.ejpn.2019.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/19/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022]
Abstract
AIM To investigate health-related quality of life (HRQOL) and manual ability five years after neonatal arterial ischemic stroke (NAIS). METHODS Data was prospectively obtained by the Swiss Neuropaediatric Stroke Registry between 2000 and 2010. Two years after NAIS, cognitive and motor outcomes was assessed using the Bayley Scales of Infant Development (BSID-II). After 5 years, HRQOL was assessed with the KIDSCREEN-27 and manual ability with the ABILHAND-Kids. Manual ability and HRQOL were compared between children with and without cerebral palsy (CP) and HRQOL was correlated with manual ability. RESULTS Seventy-four patients were examined at the age of 2 years, at the age of 5 years 61 patients underwent a follow-up examination. Two years after NAIS, 29 children (39.1%) were diagnosed with CP. HRQOL 5 years after NAIS was comparable to normative values. Children with CP had a significantly lower HRQOL-index (p = 0.013) and lower scores in the subscale psychological well-being (p = 0.012) and social support & peers (p = 0.048). The ABILHAND-Kids measure was significantly lower in children with CP compared to children without CP (p < 0.001). Manual ability correlated significantly with HRQOL. CONCLUSION Five years after NAIS, HRQOL is comparable to that of typically developing peers, but reduced in children with CP. Poorer manual ability is associated with lower HRQOL. Interventions improving hand function might influence HRQOL and should be considered early on.
Collapse
|
10
|
Ghotra SK, Johnson JA, Qiu W, Newton AS, Rasmussen C, Yager JY. Health-related quality of life and its determinants in paediatric arterial ischaemic stroke survivors. Arch Dis Child 2018. [PMID: 29519944 DOI: 10.1136/archdischild-2017-313334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Health-related quality of life (HRQL) instruments are patient or proxy-reported outcome measures that provide a comprehensive and subjective assessment of patient's well-being and hence vital for health outcomes evaluation. A clear and thorough understanding of HRQL and its determinants is especially important to appropriately guide health-improving interventions. In this study, HRQL of paediatric arterial ischaemic stroke survivors was assessed using guidelines recommended for interpretation and reporting of the patient-reported outcome data. Determinants of HRQL were also explored. METHODS Children diagnosed with arterial ischaemic stroke between 2003 and 2012 were assessed at least 1 year poststroke using the parent-proxy report versions of the Pediatric Quality of Life Inventory 4.0 and Pediatric Stroke Recurrence and Recovery Questionnaire. HRQL data were compared with population norms and used as outcome in multiple linear regression analysis. RESULTS 59 children were evaluated. Mean age at diagnosis of stroke was 2.2 years. Mean age at assessment and time elapsed since stroke was 7 years and 5 years, respectively. A total of 41% children had normal global outcome, whereas 51% had moderate to severe deficits. A lower overall HRQL was observed in both self and proxy reports. Parents reported the maximum impairment in emotional domain, whereas children indicated physical functioning to be the most affected. Neurological outcome, site of stroke and socioeconomic status were independently associated with overall HRQL. CONCLUSIONS Lower HRQL was demonstrated in children who survived arterial ischaemic stroke. Socioeconomic status of families was an important determinant of HRQL, over and above clinical parameters.
Collapse
Affiliation(s)
- Satvinder K Ghotra
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Carmen Rasmussen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Y Yager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
11
|
Fiume A, Deveber G, Jang SH, Fuller C, Viner S, Friefeld S. Development and validation of the Pediatric Stroke Quality of Life Measure. Dev Med Child Neurol 2018; 60:587-595. [PMID: 29451699 DOI: 10.1111/dmcn.13684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/26/2022]
Abstract
AIM To develop and validate a disease-specific parent proxy and child quality of life (QoL) measure for patients aged 2 to 18 years surviving cerebral sinovenous thrombosis (CSVT) and arterial ischaemic stroke (AIS). METHOD Utilizing qualitative and quantitative methods, we developed a 75-item Pediatric Stroke Quality of Life Measure (PSQLM) questionnaire. We mailed the PSQLM and a standardized generic QoL measure, Pediatric Quality of Life Inventory (PedsQL), to 353 families. Stroke type, age at stroke, and neurological outcome on the Pediatric Stroke Outcome Measure were documented. We calculated the internal consistency, validity, and reliability of the PSQLM. RESULTS The response rate was 29%, yielding a sample of 101 patients (mean age 9y 9mo [SD 4.30]; 69 AIS [68.3%], 32 CSVT [31.7%]). The internal consistency of the PSQLM was high (Cronbach's α=0.94-0.97). Construct validity for the PSQLM was moderately strong (r=0.3-0.4; p<0.003) and, as expected, correlation with the PedsQL was moderate, suggesting the PSQLM operationalizes QoL distinct from the PedsQL. Test-retest reliability at 2 weeks was very good (intraclass correlation coefficient [ICC] 0.85-0.95; 95% confidence interval 0.83-0.97) and good agreement was established between parent and child report (ICC 0.63-0.76). INTERPRETATION The PSQLM demonstrates sound psychometric properties. Further research will seek to increase its clinical utility by reducing length and establishing responsiveness for descriptive and longitudinal evaluative assessment. WHAT THIS PAPER ADDS A pediatric stroke-specific quality of life (QoL) measurement tool for assessments based on perceptions of importance and satisfaction. Moderate-to-high reliability and validity established for a new clinical scale evaluating QoL among children with stroke. Perceived QoL measured using the Pediatric Stroke Quality of Life Measure appears lower in children with neurological impairment.
Collapse
Affiliation(s)
- Andrea Fiume
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Clinician Investigator Program, McMaster University, Hamilton, ON, Canada
| | - Gabrielle Deveber
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | - Shu-Hyun Jang
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Colleen Fuller
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Shani Viner
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sharon Friefeld
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
12
|
Vázquez López M, Castro de Castro P, Gil Villanueva N, Alcaraz Romero AJ, Pascual Pascual SI. Quality of life heart-disease children who have suffered from an arterial ischaemic stroke. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Vázquez López M, Castro de Castro P, Gil Villanueva N, Alcaraz Romero AJ, Pascual Pascual SI. Calidad de vida de niños cardiópatas que han sufrido un ictus arterial isquémico. An Pediatr (Barc) 2018; 88:167-169. [DOI: 10.1016/j.anpedi.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022] Open
|
14
|
O'Keeffe F, Stark D, Murphy O, Ganesan V, King J, Murphy T. Psychosocial outcome and quality of life following childhood stroke - A systematic review. Dev Neurorehabil 2017. [PMID: 28632465 DOI: 10.1080/17518423.2017.1282052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this paper was to critically review the recent literature on psychosocial and behavioral outcome following childhood stroke, to assess whether quality of life is affected and to investigate the factors related to psychosocial outcome. METHODS Literature searches were conducted and identified 36 relevant papers from the period 1908-2016. RESULTS The systematic review found that many children experience difficulties in a wide range of psychosocial domains. Quality of life can also be significantly reduced. Inconsistent findings regarding the correlates of outcome are likely due to methodological limitations. These issues include small and heterogeneous samples, lack of control groups, and measurement difficulties. CONCLUSIONS This systematic review strongly indicates that childhood stroke can affect a myriad of psychosocial domains and a child's quality of life. Methodological issues, particularly around heterogeneous samples and measures, limit the conclusions that can be drawn regarding the predictors of outcome.
Collapse
Affiliation(s)
- Fiadhnait O'Keeffe
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK.,b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Daniel Stark
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - Orlagh Murphy
- b Department of Clinical Psychology , National Rehabilitation Hospital, Dun Laoghaire, Co . Dublin , Ireland
| | - Vijeya Ganesan
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| | - John King
- a Research Department of Clinical, Health and Educational Psychology , University College London , London , UK
| | - Tara Murphy
- c Institute of Child Health, Great Ormond Street Hospital for Children NHS Trust , London , UK
| |
Collapse
|
15
|
Greenham M, Anderson V, Hearps S, Ditchfield M, Coleman L, Mackay MT, Monagle P, Gordon AL. Psychosocial function in the first year after childhood stroke. Dev Med Child Neurol 2017; 59:1027-1033. [PMID: 28121027 DOI: 10.1111/dmcn.13387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
AIM Childhood stroke disrupts brain development and emerging neural networks. Motor, cognitive, and language deficits are well recognized, yet little is known about psychosocial function after childhood stroke. This study aims to describe psychosocial function within the first year after childhood stroke, and to identify factors associated with outcome. METHOD Thirty-seven children were involved in a prospective, longitudinal study investigating recovery over the first year after childhood stroke. Children's social functioning was assessed at 6-months and 12-months poststroke and psychological function at 12-months poststroke, using standardized measures. RESULTS Mean social function was poorer at both 6-months and 12-months poststroke, compared to prestroke. Psychological problems were more common than expected, with emotional difficulties and hyperactivity-inattention most significantly affected. Poorer social function was associated with older age at onset, acute neurological impairment, and prestroke social impairment. Social and psychological problems were associated with parent mental health. INTERPRETATION While not all children are affected, psychosocial impairment affects a significant minority after childhood stroke. Older age at onset, acute neurological impairment, prestroke social problems, and poorer parent mental health were associated with deficits. Identifying early predictors of poorer outcome will facilitate early intervention. Of particular importance is parent mental health, suggesting support for families may improve child outcome.
Collapse
Affiliation(s)
- Mardee Greenham
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Vic, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Vic, Australia.,Department of Psychology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia
| | - Michael Ditchfield
- Imaging, Monash Medical Centre, Monash Health, Melbourne, Vic, Australia.,Paediatric Imaging, Monash University, Melbourne, Vic, Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Department of Medical Imaging, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Department of Neurology, The Royal Children's Hospital, Melbourne, Vic, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Vic, Australia.,Department of Haematology, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Anne L Gordon
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Vic, Australia.,Pediatric Neuroscience Department, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| |
Collapse
|
16
|
Ball AJ, Steinberg GK, Elbers J. Quality of Life in Pediatric Moyamoya Disease. Pediatr Neurol 2016; 63:60-65. [PMID: 27473648 DOI: 10.1016/j.pediatrneurol.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/10/2016] [Accepted: 06/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) is a progressive intracranial arteriopathy with high risk of stroke. Its impact on quality of life is unstudied. We surveyed children with moyamoya disease and compared their quality of life to chronically ill children and children with stroke to better understand the impact of this diagnosis. METHODS Children with moyamoya disease aged seven to 17 years from Stanford's Moyamoya Clinic between June 2014 and March 2015 were included. Children with syndromic neurodevelopmental diagnoses were excluded. Patients were surveyed using the Pediatric Quality of Life 4.0, in addition to the Pediatric Stroke Outcome Measure or Recovery Recurrence Questionnaire. Mean scores were compared to normative data sets. Linear regression models compared total quality of life scores in patients with and without stroke, after adjusting for confounders. RESULTS This cross-sectional study included 30 children with moyamoya disease; ten were male, and the median age was 13.5 years (range, 7 to 17 years). Twenty children (67%) had a stroke, and 14 of these had good neurological outcome (70%). Mean parent-proxy Pediatric Quality of Life scores were lower in all domains compared to healthy controls (P < 0.05), and all scores were comparable to chronically ill children and children with non-moyamoya disease stroke. There was no significant difference in total quality of life between patients with and without stroke. CONCLUSIONS Even in the absence of stroke, children with moyamoya disease have lower quality of life than healthy controls and a similar quality of life to chronically ill children and those with non-moyamoya disease stroke. Children with moyamoya disease would benefit from mental health support beyond what a mild physical presentation may indicate.
Collapse
Affiliation(s)
- Alexander J Ball
- School of Medicine, Stanford University School of Medicine, Stanford, California
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jorina Elbers
- Division of Child Neurology, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
17
|
Hawks C, Jordan LC, Gindville M, Ichord RN, Licht DJ, Beslow LA. Educational Placement After Pediatric Intracerebral Hemorrhage. Pediatr Neurol 2016; 61:46-50. [PMID: 27262667 PMCID: PMC4983212 DOI: 10.1016/j.pediatrneurol.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study describes educational placement of school-aged children after spontaneous intracerebral hemorrhage and examines whether educational placement is associated with severity of neurological deficits. METHODS Children with spontaneous intracerebral hemorrhage presenting from 2007 to 2013 were prospectively enrolled at three tertiary children's hospitals. The Pediatric Stroke Outcome Measure and parental interview gathered information about neurological outcome, school attendance, and educational placement. RESULTS The cohort of 92 enrolled children included 42 school-aged children (6 to 17 years) with intracerebral hemorrhage. Four children died; one was excluded because of preexisting cognitive deficits. Thirty-seven children completed three-month follow-up, and 30 completed 12-month follow-up. At 12 months, 14 children (46.7%) received regular age-appropriate programming, 12 (40%) attended school with in-class services, three (10%) were in special education programs, and one child (3.3%) received home-based services because of intracerebral hemorrhage-related deficits. Of 30 children with three- and 12-month follow-up, 14 (46.7%) improved their education status, 13 (43.3%) remained at the same education level, and three (10%) began to receive in-class services. An increasing Pediatric Stroke Outcome Measure score predicted the need for educational modifications at three months (odds ratio, 3.3; 95% confidence interval, 1.4 to 7.9; P = 0.007) and at 12 months (odds ratio, 2.1; 95% confidence interval, 1.1 to 3.9; P = 0.025). CONCLUSIONS Most children returned to school within a year after intracerebral hemorrhage, and many had a reduction in the intensity of educational support. However, a great need for educational services persisted at 12 months after intracerebral hemorrhage with fewer than half enrolled in regular age-appropriate classes. Worse deficits on the Pediatric Stroke Outcome Measure were associated with remedial educational placement.
Collapse
Affiliation(s)
- Charlotte Hawks
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa Gindville
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Rebecca N. Ichord
- Division of Child Neurology, Children’s Hospital of Philadelphia, Pereleman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Daniel J. Licht
- Division of Child Neurology, Children’s Hospital of Philadelphia, Pereleman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Lauren A. Beslow
- Departments of Neurology and Pediatric Neurology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
18
|
Greenham M, Hearps S, Gomes A, Rinehart N, Gonzalez L, Gordon A, Mackay M, Lo W, Yeates K, Anderson V. Environmental Contributions to Social and Mental Health Outcomes Following Pediatric Stroke. Dev Neuropsychol 2016; 40:348-62. [PMID: 26491988 DOI: 10.1080/87565641.2015.1095191] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mental health and social outcomes following acquired brain injury (ABI) in children are often considered to be due to brain insult, but other factors, such as environment, may also play a role. We assessed mental health and social function in children with chronic illness, with and without stroke (a form of ABI), and typically developing (TD) controls to examine environmental influences on these outcomes. We recruited 36 children diagnosed with stroke, 15 with chronic asthma, and 43 TD controls. Children and parents completed questionnaires rating child mental health and social function and distal and proximal environment. TD children had significantly less internalizing and social problems than stroke and asthma groups, and engaged in more social activities than children with stroke. Poorer parent mental health predicted more internalizing and social problems and lower social participation. Family dysfunction was associated with internalizing problems. Lower parent education contributed to children's social function. Children with chronic illness are at elevated risk of poorer mental health and social function. Addition of brain insult leads to poorer social participation. Quality of home environment contributes to children's outcomes, suggesting that supporting parent and family function provides an opportunity to optimize child mental health and social outcomes.
Collapse
Affiliation(s)
- Mardee Greenham
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia.,b School of Psychological Sciences , University of Melbourne , Melbourne , Australia
| | - Stephen Hearps
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia
| | - Alison Gomes
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia.,c School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Nicole Rinehart
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia.,d School of Psychology , Deakin University , Melbourne , Australia
| | - Linda Gonzalez
- c School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Anne Gordon
- e Paediatric Neurology , Evelina London Children's Hospital , London , United Kingdom.,f Institute of Psychology, Psychiatry & Neuroscience , Kings College London , London , United Kingdom
| | - Mark Mackay
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia.,g Department of Neurology , Royal Children's Hospital , Melbourne , Australia.,h Department of Paediatrics , University of Melbourne , Melbourne , Australia
| | - Warren Lo
- i Neurosciences Centre , Nationwide Children's Hospital , Columbus , Ohio
| | - Keith Yeates
- i Neurosciences Centre , Nationwide Children's Hospital , Columbus , Ohio
| | - Vicki Anderson
- a Clinical Sciences , Murdoch Childrens Research Institute , Melbourne , Australia.,b School of Psychological Sciences , University of Melbourne , Melbourne , Australia
| |
Collapse
|
19
|
Smith SE, Vargas G, Cucchiara AJ, Zelonis SJ, Beslow LA. Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children. Pediatr Neurol 2015; 52:428-34. [PMID: 25559938 PMCID: PMC4556437 DOI: 10.1016/j.pediatrneurol.2014.11.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal and childhood stroke result in neurological impairment in the majority of survivors, but less is known about patient and parent perception of function following stroke in children. Our aim was to characterize parent-proxy and child-reported health status in children following unilateral arterial ischemic stroke or intraparenchymal hemorrhage. METHODS Fifty-nine children 2-18 years (30 girls, 29 boys) with unilateral arterial ischemic stroke or spontaneous intraparenchymal hemorrhage at least 6 months before evaluation were enrolled from a single center. The PedsQL version 4.0 Generic Short Form and PedsQL version 3.0 Cerebral Palsy Module were administered to childhood stroke subjects and parents. Generic PedsQL Inventory scores were compared between children with stroke and published data from healthy children. Reported health status scores for children with varying degrees of hemiparesis were compared. RESULTS Children with stroke had lower reported health status scores on the Generic PedsQL Inventory than healthy children. Children with moderate-severe hemiparesis had worse scores than children without hemiparesis on several measures of the Cerebral Palsy Module as reported by both parents and children. The parents of children with epilepsy reported worse scores on several measures compared with children without epilepsy, and the parent scores were lower on several measures for children with lower intelligence quotients. Agreement between parent and child scores was better on the Cerebral Palsy Module than on the Generic Inventory. CONCLUSIONS Children with stroke have worse reported health status than healthy controls. Degree of hemiparesis, epilepsy, and lower intelligence quotient affect reported health status on some measures. Agreement between parent-proxy and child scores ranges from slight to good which suggests that both provide useful information.
Collapse
Affiliation(s)
- Sabrina E. Smith
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Division of Pediatric Neurology, Kaiser Permanente Oakland Medical Center, Oakland, California,Communications should be addressed to: Dr. Sabrina E. Smith; Division of Pediatric Neurology; Kaiser Permanente Oakland Medical Center; 275 W. MacArthur Blvd.; Oakland; CA 94611.
| | - Gray Vargas
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Psychology, Penn State University, University Park, Pennsylvania
| | - Andrew J. Cucchiara
- Clinical and Translational Research Center, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah J. Zelonis
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A. Beslow
- Department of Neurology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut,Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
20
|
Gordon AL. Functioning and disability after stroke in children: using the ICF-CY to classify health outcome and inform future clinical research priorities. Dev Med Child Neurol 2014; 56:434-44. [PMID: 24341384 DOI: 10.1111/dmcn.12336] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Abstract
AIM The International Classification of Functioning Disability and Health, Child-Youth version (ICF-CY) provides a framework for describing and evaluating health, intervention outcomes, and needs assessment. It can, however, also serve as a system for classifying the focus of outcome studies and identification of gaps in current knowledge. METHOD The paediatric arterial ischaemic stroke (AIS) population was targeted. Multiple databases were systematically searched for AIS outcome studies focussing on functioning or disability. Findings were rated using the ICF-CY framework. RESULTS Twenty-eight studies were identified. Most were cross-sectional and age range at assessment varied widely. Sixty-seven different standardized measures were used, predominantly evaluating body functions. The most common domains of activity and participation reported were learning and applying knowledge, general tasks and demands, and self-care skills. Health-related quality of life was measured in nine papers. Environmental factors were rarely evaluated. INTERPRETATION AIS outcome studies addressing the relationship between body structures and functions (e.g. brain lesion characteristics, neurological examination findings) and activities, participation, and quality of life have emerged in recent years. Comparison of findings across studies is complicated by design and tool selection. The relationship between components of activity limitation and participation restriction is rarely explored.
Collapse
Affiliation(s)
- Anne L Gordon
- Paediatric Neurosciences Department, Evelina London Children's Hospital, Guy's & St Thomas' Hospital NHS Foundation Trust, Kings Health Partners, London, UK; Clinical Sciences Theme, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| |
Collapse
|
21
|
Kapadia NM, Nagai MK, Zivanovic V, Bernstein J, Woodhouse J, Rumney P, Popovic MR. Functional electrical stimulation therapy for recovery of reaching and grasping in severe chronic pediatric stroke patients. J Child Neurol 2014; 29:493-9. [PMID: 23584687 DOI: 10.1177/0883073813484088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke affects 2.7 children per 100,000 annually, leaving many of them with lifelong residual impairments despite intensive rehabilitation. In the present study the authors evaluated the effectiveness of 48 hours of transcutaneous functional electrical stimulation therapy for retraining voluntary reaching and grasping in 4 severe chronic pediatric stroke participants. Participants were assessed using the Rehabilitation Engineering Laboratory Hand Function Test, Quality of Upper Extremity Skills Test, Pediatric Evaluation of Disability Inventory, and Assisting Hand Assessment. All participants improved on all measures. The average change scores on selected Rehabilitation Engineering Laboratory Hand Function Test components were 14.5 for object manipulation (P = .042), 0.78 Nm for instrumented cylinder (P = .068), and 14 for wooden blocks (P = .068) and on the grasp component of Quality of Upper Extremity Skills Test was 25.93 (P = .068). These results provide preliminary evidence that functional electrical stimulation therapy has the potential to improve upper limb function in severe chronic pediatric stroke patients.
Collapse
Affiliation(s)
- Naaz M Kapadia
- 1Toronto Rehabilitation Institute, University Hospital Network, Toronto, Canada
| | | | | | | | | | | | | |
Collapse
|
22
|
Mallick AA, O’Callaghan FJK. Risk factors and treatment outcomes of childhood stroke. Expert Rev Neurother 2014; 10:1331-46. [DOI: 10.1586/ern.10.106] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
23
|
|
24
|
Kitchen L, Westmacott R, Friefeld S, MacGregor D, Curtis R, Allen A, Yau I, Askalan R, Moharir M, Domi T, deVeber G. The Pediatric Stroke Outcome Measure. Stroke 2012; 43:1602-8. [DOI: 10.1161/strokeaha.111.639583] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lisa Kitchen
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Robyn Westmacott
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Sharon Friefeld
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Daune MacGregor
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Rosalind Curtis
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Anita Allen
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Ivanna Yau
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Rand Askalan
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Mahendranath Moharir
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Trish Domi
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| | - Gabrielle deVeber
- From the Children's Stroke Program (L.K., R.W., D.M., R.C., A.A., I.Y., R.A., M.M., T.D., G.d.V.), the Department of Psychology (R.W.), and the Division of Neurology (D.M., A.A., I.Y., R.A., M.M., G.d.V.), The Hospital for Sick Children, Toronto, Canada; and the Department of Occupational Science and Occupational Therapy (S.F.) and the Faculty of Medicine (S.F., D.M., I.Y., R.A., M.M., G.d.V.), University of Toronto, Toronto, Canada
| |
Collapse
|
25
|
O'Keeffe F, Ganesan V, King J, Murphy T. Quality-of-life and psychosocial outcome following childhood arterial ischaemic stroke. Brain Inj 2012; 26:1072-83. [PMID: 22642370 DOI: 10.3109/02699052.2012.661117] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fiadhnait O'Keeffe
- Research Department of Clinical, Health and Educational Psychology, University College London, London, UK.
| | | | | | | |
Collapse
|
26
|
Friefeld SJ, Westmacott R, Macgregor D, Deveber GA. Predictors of quality of life in pediatric survivors of arterial ischemic stroke and cerebral sinovenous thrombosis. J Child Neurol 2011; 26:1186-92. [PMID: 21836124 DOI: 10.1177/0883073811408609] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Predictors of quality of life can define potentially modifiable factors to increase favorable outcomes after pediatric stroke. Quality of life was measured using the Centre for Health Promotion's Quality of Life Profile (CHP-QOL) in 112 children surviving arterial ischemic stroke or cerebral sinovenous thrombosis at mean 3 years after stroke. Overall quality of life was poor in 17.8% children despite mean scores (3.52) in the "adequate" range. Quality of life related to school and play was most problematic and that related to physical and home environment was least problematic. Female gender, cerebral sinovenous thrombosis stroke, and older age at testing predicted reduced overall and domain-specific quality of life (P < .05), whereas neurological outcome and family socioeconomic status did not. Cognitive/behavioral deficit and low Verbal IQ adversely affected socialization and quality of life, especially among older children and females. Altered cognition/behavior has a major impact on quality of life after pediatric stroke. Implementation of ameliorative strategies warrants further study.
Collapse
Affiliation(s)
- Sharon J Friefeld
- University of Toronto, Department of Occupational Science and Occupational Therapy, Toronto, Canada.
| | | | | | | |
Collapse
|
27
|
Abstract
BACKGROUND Paediatric stroke has a significant impact on functional ability; however, few studies describe outcomes using valid and reliable measures. AIM To describe functional abilities of children following ischemic stroke using a validated outcome measure. METHODS Eighteen children who had sustained an ischemic stroke were recruited from the stroke service of a tertiary children's hospital. The Pediatric Evaluation of Disability Inventory (PEDI) was used to describe functional abilities in domains of self-care, mobility and social function. RESULTS All children demonstrated lower functional skills and required more caregiver assistance than would be expected for their age. These findings were seen across all functional areas; however, self-care was more affected than mobility and social functions. CONCLUSION The PEDI provides a useful measure of functional outcomes following paediatric stroke. Children in this study demonstrated reduced abilities across all domains. Further research to investigate the relationship between location of injury and functional outcome would assist understanding of paediatric stroke outcomes.
Collapse
Affiliation(s)
- Jane Galvin
- Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Melbourne, Australia.
| | | | | | | |
Collapse
|
28
|
Neuner B, von Mackensen S, Krümpel A, Manner D, Friefeld S, Nixdorf S, Frühwald M, deVeber G, Nowak-Göttl U. Health-related quality of life in children and adolescents with stroke, self-reports, and parent/proxies reports: Cross-sectional investigation. Ann Neurol 2011; 70:70-8. [DOI: 10.1002/ana.22381] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/17/2010] [Accepted: 01/14/2011] [Indexed: 11/06/2022]
|
29
|
Bulder M, Hellmann P, van Nieuwenhuizen O, Kappelle L, Klijn C, Braun K. Measuring Outcome after Arterial Ischemic Stroke in Childhood with Two Different Instruments. Cerebrovasc Dis 2011; 32:463-70. [DOI: 10.1159/000332087] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 08/23/2011] [Indexed: 11/19/2022] Open
|
30
|
Abstract
AIM To evaluate the long-term outcome of childhood stroke in a population-based cohort of Swedish children. METHODS We followed up children with stroke over 7 years from 2000 to 2006 in a health care region covering one-fifth of the Swedish population. Children aged between 28 days and 18 years, who had arterial ischaemic stroke, cerebral sinus venous stroke or nontraumatic haemorrhagic stroke, were included. The long-term outcome study 1.6-8.6 years later included a clinical investigation, evaluation of school performance, everyday activities and participation and health-related quality of life questionnaires (International Classification of Functioning, Disability and Health, Child Health Questionnaire and Short-Form General Health Survey). RESULTS Of 51 children, 4 (8%) had died and 85% of the long-term survivors had some acquired impairment: 65% of the children had neurological impairment, and 59% had deficits affecting school activity and participation. The parents experienced the negative effect of the stroke on their child's general health, daily life activities and participation and also on their own family life. CONCLUSION Childhood stroke results in serious long-term functional deficits in 85% of survivors affecting their everyday life, the child's performances and the life of the family as a whole.
Collapse
Affiliation(s)
- S Christerson
- Centre for Rehabilitation Research and Paediatric Clinic, Örebro University Hospital, Sweden.
| | | |
Collapse
|
31
|
Varni JW, Burwinkle TM, Seid M. The PedsQL as a pediatric patient-reported outcome: reliability and validity of the PedsQL Measurement Model in 25,000 children. Expert Rev Pharmacoecon Outcomes Res 2010; 5:705-19. [PMID: 19807613 DOI: 10.1586/14737167.5.6.705] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The PedsQL Measurement Model was designed as a modular approach to measuring pediatric health-related quality of life, and developed to integrate the relative merits of generic and disease-specific approaches. The PedsQL 4.0 Generic Core Scales have been translated into over 60 languages, with published data on over 25,000 children and adolescents in more than 75 peer-reviewed journals since 2001 for healthy children and numerous pediatric chronic health conditions. The PedsQL Disease and Condition-Specific Modules were designed to measure health-related quality-of-life dimensions specifically tailored for pediatric chronic health conditions, and include the PedsQL Asthma, Arthritis/Rheumatology, Cancer, Diabetes, Cardiac and Cerebral Palsy Modules, as well as the generic PedsQL Multidimensional Fatigue Scale, Pediatric Pain Questionnaire, Family Impact Module and Healthcare Satisfaction Module. The PedsQL has demonstrated reliability, validity, sensitivity and responsiveness for child self report for ages 5-18 years and parent proxy report for ages 2-18 years. The PedsQL has been shown to be related to other key constructs in pediatric healthcare such as access to needed care, healthcare barriers and quality of primary care. Future advances in the PedsQL() Measurement Model include web-based electronic administration (ePedsQL), integration into the electronic medical record, further efficacy and effectiveness outcome trials, including PedsQL ResourceConnect(SM) and PedsQL TIPS(SM), the development of the generic PedsQL Infant Scales for ages birth to 24 months and disease and condition-specific modules for other pediatric chronic health conditions.
Collapse
Affiliation(s)
- James W Varni
- College of Architecture, Texas A&M University, College Station, TX 77843-3137, USA.
| | | | | |
Collapse
|
32
|
Sachdev A, Sharma R, Gupta D. Cerebrovascular complications in pediatric intensive care unit. Indian J Crit Care Med 2010; 14:129-40. [PMID: 21253346 PMCID: PMC3021828 DOI: 10.4103/0972-5229.74171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Cerebrovascular complications are being frequently recognized in the pediatric intensive care unit in the recent few years. The epidemiology and risk factors for pediatric stroke are different from that of the adults. The incidence of ischemic stroke is almost slightly more than that of hemorrhagic stroke. The list of diagnostic causes is increasing with the availability of newer imaging modalities and laboratory tests. The diagnostic work up depends on the age of the child and the rapidity of presentation. Magnetic resonance imaging, computerized tomography and arteriography and venography are the mainstay of diagnosis and to differentiate between ischemic and hemorrhagic events. Very sophisticated molecular diagnostic tests are required in a very few patients. There are very few pediatric studies on the management of stroke. General supportive management is as important as the specific treatment. Most of the treatment guidelines and suggestions are extrapolated from the adult studies. Few guidelines are available for the use of anticoagulants and thrombolytic agents in pediatric patients. So, our objective was to review the available literature on the childhood stroke and to provide an insight into the subject for the pediatricians and critical care providers.
Collapse
Affiliation(s)
- Anil Sachdev
- From: Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi, India
| | - Rachna Sharma
- Department of Pediatrics, Dr. B. L. Kapoor Memorial Hospital, Pusa Road, New Delhi, India
| | - Dhiren Gupta
- From: Department of Pediatrics, Sir Ganga Ram Hospital, New Rajinder Nagar, New Delhi, India
| |
Collapse
|
33
|
Cadilhac DA, Lannin NA, Anderson CS, Levi CR, Faux S, Price C, Middleton S, Lim J, Thrift AG, Donnan GA. Protocol and Pilot Data for Establishing the Australian Stroke Clinical Registry. Int J Stroke 2010; 5:217-26. [DOI: 10.1111/j.1747-4949.2010.00430.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Disease registries assist with clinical practice improvement. The Australian Stroke Clinical Registry aims to provide national, prospective, systematic data on processes and outcomes for stroke. We describe the methods of establishment and initial experience of operation. Methods Australian Stroke Clinical Registry conforms to new national operating principles and technical standards for clinical quality registers. Features include: online data capture from acute public and private hospital sites; opt-out consent; expert consensus agreed core minimum dataset with standard definitions; outcomes assessed at 3 months post-stroke; formal governance oversight; and formative evaluations for improvements. Results Qualitative feedback from sites indicates that the web-tool is simple to use and the user manuals, data dictionary, and training are appropriate. However, sites desire automated data-entry methods for routine demography variables and the opt-out consent protocol has sometimes been problematic. Data from 204 patients (median age 71 years, 54% males, 60% Australian) were collected from four pilot hospitals from June to October 2009 (mean, 50 cases per month) including ischaemic stroke (in 72%), intracerebral haemorrhage (16%), transient ischaemic attack (9%), and undetermined (3%), with only one case opting out. Conclusion Australian Stroke Clinical Registry has been well established, but further refinements and broad roll-out are required before realising its potential of improving patient care through clinician feedback and allowance of local, national, and international comparative data.
Collapse
Affiliation(s)
- Dominique A. Cadilhac
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
| | - Natasha A. Lannin
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Craig S. Anderson
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christopher R. Levi
- University of Newcastle & Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Steven Faux
- St Vincent's Hospital, Sydney, NSW, Australia
| | - Chris Price
- National Stroke Foundation, Acute Services Division, Melbourne, Vic., Australia
| | - Sandy Middleton
- St Vincent's Hospital, Sydney, NSW, Australia
- Australian Catholic University, Sydney, NSW, Australia
| | - Joyce Lim
- Neurological and Mental Health Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney, Australia
| | - Amanda G. Thrift
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department Epidemiology & Preventive Medicine, Monash University, Prahran, Vic., Australia
- Baker IDI Heart and Diabetes Institute, St Kilda Road Central, Melbourne, Vic., Australia
| | - Geoffrey A. Donnan
- National Stroke Research Institute a subsidiary of Florey Neuroscience Institutes, Heidelberg Heights, Vic., Australia
- Department of Medicine, The University of Melbourne, Melbourne, Vic., Australia
- Florey Neurosciences Institutes, Melbourne, Vic., Australia
| |
Collapse
|
34
|
Cnossen MH, Aarsen FK, Akker SLVD, Danen R, Appel IM, Steyerberg EW, Catsman-Berrevoets CE. Paediatric arterial ischaemic stroke: functional outcome and risk factors. Dev Med Child Neurol 2010; 52:394-9. [PMID: 20089051 DOI: 10.1111/j.1469-8749.2009.03580.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To study functional outcome in children aged 1 month to 18 years after paediatric arterial ischaemic stroke (PAIS) and to identify risk factors influencing their quality of life. METHOD In a consecutive series of 76 children (35 males 41 females, median age at diagnosis 2y 6mo, range 1mo-17y 2mo; median length of follow-up 2y 4mo, range [7mo-10y 6mo]) with PAIS diagnosed at the Erasmus Medical Centre Sophia Children's Hospital between 1997 and 2006, we collected clinical, biochemical, and radiological data prospectively. In 66 children surviving at least 1 year after PAIS, functional outcome could be evaluated with the World Health Organization's International Classification of Impairments, Disabilities and Handicaps. RESULTS Significant risk factors at presentation for a poor neurological outcome were young age, infarction in the right middle cerebral artery territory, and fever at presentation. Fifty-four % of children had severe neurological impairments at 12 months after PAIS, and at last follow-up more than half needed remedial teaching, special education, or institutionalization. Health-related quality of life (HRQOL) questionnaires showed a significantly lower HRQOL in all age groups. Children with a longer follow-up had a lower HRQOL in the cognitive functioning domain. INTERPRETATION Our study shows significant morbidity and mortality and a reduced HRQOL after PAIS depending on age, fever at presentation, and infarction in the right middle cerebral artery territory.
Collapse
Affiliation(s)
- Marjon H Cnossen
- Department of Paediatric Oncology and Haematology, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
35
|
Gardner MA, Hills NK, Sidney S, Johnston SC, Fullerton HJ. The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort. Neurology 2010; 74:372-8. [PMID: 20054007 DOI: 10.1212/wnl.0b013e3181cbcd48] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite increasing awareness of the long-term impact of pediatric stroke, there are few estimates of the costs of care. We examined acute and 5-year direct costs of neonatal and childhood stroke in a population-based cohort in Northern California. METHODS We obtained electronic cost data for 266 children with neurologist-confirmed strokes, and 786 age-matched stroke-free controls, within the population of all children (<20 years) enrolled in a large managed care plan from 1996 through 2003. Cost data included all inpatient and outpatient health service costs including care at out-of-plan facilities. Costs were assessed for 5 years after stroke, expressed in 2003 US dollars, and stratified by age at stroke onset (neonatal, defined as <29 days of life, vs childhood). Stroke costs were adjusted for costs in stroke-free age-matched controls. RESULTS Average adjusted 5-year costs for pediatric stroke are substantial: $51,719 for neonatal stroke and $135,161 for childhood stroke. The average cost of a childhood stroke admission was $81,869. The average birth admission cost for a neonatal stroke was $39,613; adjustment for control birth admission costs reduced this by only $4,792, suggesting the stroke accounted for 88% of costs. Even among neonates whose strokes were not recognized until later in childhood ("presumed perinatal strokes"), admission costs exceeded those of controls. Chronic costs were highest in the first year poststroke, but continued to exceed control costs even in the fifth year by an average of $2,016. CONCLUSIONS The economic burden of neonatal and childhood stroke is both large and sustained.
Collapse
Affiliation(s)
- M A Gardner
- Department og Pediatrics, University of California, San Francisco, Department of Neurology, San Francisco, CA 94143-0114, USA
| | | | | | | | | |
Collapse
|
36
|
|
37
|
Rafay MF, Pontigon AM, Chiang J, Adams M, Jarvis DA, Silver F, MacGregor D, deVeber GA. Delay to Diagnosis in Acute Pediatric Arterial Ischemic Stroke. Stroke 2009; 40:58-64. [PMID: 18802206 DOI: 10.1161/strokeaha.108.519066] [Citation(s) in RCA: 184] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
For the clinician, the diagnosis of arterial ischemic stroke (AIS) in children is a challenge. Prompt diagnosis of pediatric AIS within 6 hours enables stroke-specific thrombolytic and neuroprotective strategies.
Methods—
We conducted a retrospective study of prospectively enrolled consecutive cohort of children with AIS, admitted to The Hospital for Sick Children, Toronto, from January 1992 to December 2004. The data on clinical presentation, symptom onset, emergency department arrival, neuroimaging and stroke diagnosis were recorded. The putative predictors of delayed diagnosis were selected a priori for analysis.
Results—
A total of 209 children with AIS were studied. The median interval from symptom onset to AIS diagnosis was 22.7 hours (interquartile range: 7.1 to 57.7 hours), prehospital delay (symptom onset to hospital arrival) was 1.7 hours (interquartile range: 49 minutes to 8.1 hours), and the in-hospital delay (presentation to diagnosis) was 12.7 hours (interquartile range: 4.5 to 33.5 hours). The initial assessment was completed in 16 minutes and initial neuroimaging in 8.8 hours. The diagnosis of AIS was suspected on initial assessment in 79 (38%) children and the initial neuroimaging diagnosed AIS in 47%. The parent’s help seeking action, nonabrupt onset of symptoms, altered consciousness, milder stroke severity, posterior circulation infarction and lack of initial neuroimaging at a tertiary hospital were predictive delayed AIS diagnosis.
Conclusion—
In the diagnosis of AIS, significant prehospital and in-hospital delays exist in children. Several predictors of the delayed AIS diagnosis were identified in the present study. Efforts to target these predictors can reduce diagnostic delays and optimize the management of AIS in children.
Collapse
Affiliation(s)
- Mubeen F. Rafay
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Ann-Marie Pontigon
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Jackie Chiang
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Margaret Adams
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - D. Anna Jarvis
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Frank Silver
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Daune MacGregor
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| | - Gabrielle A. deVeber
- From the Section of Neurology (M.F.R.), Department of Pediatrics and Child Health, University of Manitoba, the Population Health Sciences Program (M.F.R., A.-M.P., J.C., M.A., G.A.d.V.), the Division of Emergency Medicine (D.A.J.), and the Division of Neurology (D.M., G.A.d.V.), The Hospital for Sick Children, Toronto, Ontario, Canada; and the Division of Neurology (F.S.), University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
38
|
|
39
|
Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER. Management of Stroke in Infants and Children. Stroke 2008; 39:2644-91. [PMID: 18635845 DOI: 10.1161/strokeaha.108.189696] [Citation(s) in RCA: 743] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
40
|
Upton P, Lawford J, Eiser C. Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res 2008; 17:895-913. [PMID: 18521721 DOI: 10.1007/s11136-008-9350-5] [Citation(s) in RCA: 515] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 04/16/2008] [Indexed: 02/08/2023]
Abstract
AIM To systematically review the literature published since 1999 on paediatric health-related quality of life (HRQL) in relation to parent-child agreement. METHODS Literature searches used to identify studies which evaluated parent-child agreement for child HRQL measures. RESULTS Nineteen studies were identified, including four HRQL instruments. The Pediatric Quality of Life Inventory (PedsQL) was most commonly used. Differences in parent-child agreement were noted between domains for different measures. The impact of child and parent characteristics were not consistently considered; however parents of children in a nonclinical sample tended to report higher child HRQL scores than children themselves, while parents of children with health conditions tended to underestimate child HRQL. CONCLUSION Despite increasing numbers of studies considering children's HRQL, information about variables contributing to parent-child agreement levels remains limited. Authors need to consistently provide evidence for reliability and validity of measures, and design studies to systematically investigate variables that impact on levels of parent-child agreement.
Collapse
Affiliation(s)
- Penney Upton
- Department of Psychology and Health Sciences, University of Worcester, Worcester WR2 6AJ, UK.
| | | | | |
Collapse
|
41
|
Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial. Lancet Neurol 2008; 7:507-13. [DOI: 10.1016/s1474-4422(08)70096-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
42
|
Lo W, Zamel K, Ponnappa K, Allen A, Chisolm D, Tang M, Kerlin B, Yeates KO. The Cost of Pediatric Stroke Care and Rehabilitation. Stroke 2008; 39:161-5. [DOI: 10.1161/strokeaha.107.497420] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Warren Lo
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Khaled Zamel
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Kavita Ponnappa
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Antoni Allen
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Deena Chisolm
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Monica Tang
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Bryce Kerlin
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| | - Keith O. Yeates
- From the Departments of Pediatrics and Psychology, The Ohio State University and Children’s Hospital, Columbus, Ohio
| |
Collapse
|
43
|
Grange A, Bekker H, Noyes J, Langley P. Adequacy of health-related quality of life measures in children under 5 years old: systematic review. J Adv Nurs 2007; 59:197-220. [PMID: 17627625 DOI: 10.1111/j.1365-2648.2007.04333.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. BACKGROUND Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. METHODS A methodological systematic review was carried out for the period 1980-2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. RESULTS Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0-8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. CONCLUSION There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children.
Collapse
Affiliation(s)
- Angela Grange
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK. [corrected]
| | | | | | | |
Collapse
|
44
|
Abstract
Background and Purpose—
Few pediatric reports of thrombolysis exist. We sought to determine national rates of thrombolysis among pediatric ischemic stroke patients using a national database.
Methods—
Patients between the ages of 1 and 17 years, entered in the Nationwide Inpatient Sample between 2000 and 2003, with International Classification of Diseases codes for ischemic stroke were included in the study. Differences in mean age, gender distribution, ethnicity, secondary diagnoses, medical complications, associated procedure rates, modes of discharge, and hospital costs between pediatric stroke patients receiving and not receiving thrombolysis were estimated.
Results—
In the United States, between 2000 and 2003 an estimated 2904 children were admitted with ischemic stroke, of which 46 children (1.6%) received thrombolytic therapy. Children who received thrombolysis were on the average older (11 versus 9 years), more likely to be male (100% versus 53.8%), with significantly higher hospital costs ($81 800 versus $38 700). These children were also less likely to be discharged home with higher rates of death and dependency, although differences in clinical severity between the 2 groups was not known.
Conclusion—
Thrombolysis, though not indicated for patients <18 years of age, is currently being administered to children, with unclear benefit. Larger studies are needed to evaluate the safety and efficacy of this treatment for children.
Collapse
Affiliation(s)
- Nazli Janjua
- Long Island College Hospital, Department of Neurology, Brooklyn, NY 11201, USA.
| | | | | | | |
Collapse
|
45
|
Ding R, McCarthy ML, Houseknecht E, Ziegfeld S, Knight VM, Korehbandi P, Parnell D, Klotz P. The health-related quality of life of children with an extremity fracture: a one-year follow-up study. J Pediatr Orthop 2006; 26:157-63. [PMID: 16557127 DOI: 10.1097/01.bpo.0000218521.98244.7e] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To document the health-related quality of life (HRQOL) of children with an extremity fracture at 3 and 12 months postinjury and to determine whether it varies significantly by fracture region and site. METHODS Children hospitalized for an extremity fracture at 4 pediatric trauma centers were studied. A baseline, 3-month, and 12-month telephone interview were completed by a primary caregiver to measure the child's HRQOL using the Pediatric Quality of Life Inventory (PedsQL). HRQOL was modeled as a function of injury, patient, and family characteristics using a longitudinal regression model. RESULT Of the 100 children enrolled, 52 sustained a lower extremity fracture (LEF) and 48 an upper extremity fracture (UEF). Postinjury HRQOL scores were significantly poorer than preinjury scores for all subjects (P = 0.05). In addition, a significant proportion of subjects reported impaired physical and psychosocial HRQOL at 3 (44% and 46%, respectively) and 12 months (23% and 33%, respectively) postinjury. At 3 months postinjury, children with an LEF had significantly poorer HRQOL outcomes compared to children with a UEF. By 12 months postinjury, the physical function of children with a tibia and/or fibula fracture remained significantly lower than children with a UEF (P < or = 0.05). CONCLUSIONS Children hospitalized for an extremity fracture suffered dramatic declines in physical and psychosocial well-being during the first 3 months postinjury. By 1 year postinjury, most children recovered; however, children with a tibia and/or fibula fracture still reported significantly poorer physical functioning.
Collapse
Affiliation(s)
- Ru Ding
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21209, USA.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Evidence-based therapeutic interventions for pediatric ischemic cerebrovascular disease are beginning to emerge. The primary therapeutic target is usually the pathological prothrombotic disturbance that underlies the majority of pediatric stroke. A battle between anticoagulation and anti-platelet therapies continues to provide controversy and is the inspiration for upcoming randomized trials. Supportive care and neuroprotective strategies are an important consideration in children with stroke. Attempts to determine the safety of acute thrombolytic interventions are also underway. Finally, unique medical and surgical treatments for specific diseases leading to stroke in children continue to evolve. After briefly summarizing the epidemiology, pathophysiology, diagnosis, and outcomes of ischemic strokes in children, treatment approaches and alternatives will be reviewed in detail with emphasis placed on current areas of controversy and future directions for clinical research.
Collapse
Affiliation(s)
- Adam Kirton
- Children’s Stroke Program, Department of Pediatrics, Division of Neurology, Faculty of Medicine, University of Toronto, Hospital for Sick Children, M5G 1X8 Toronto, ON Canada
| | - Gabrielle deVeber
- Children’s Stroke Program, Department of Pediatrics, Division of Neurology, Faculty of Medicine, University of Toronto, Hospital for Sick Children, M5G 1X8 Toronto, ON Canada
| |
Collapse
|
47
|
|
48
|
Massicotte MP, Sofronas M, deVeber G. Difficulties in performing clinical trials of antithrombotic therapy in neonates and children. Thromb Res 2005; 118:153-63. [PMID: 16009401 DOI: 10.1016/j.thromres.2005.05.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 05/18/2005] [Accepted: 05/19/2005] [Indexed: 11/17/2022]
Abstract
The practice of evidence-based medicine is based on the results of properly designed, conducted and analyzed studies. Evidence for the safety and efficacy of therapies is established through clinical trials. However, there are a number of difficulties in the design and management of clinical trials in children. We explore the theoretical and ethical issues and difficulties of designing and conducting clinical trials in children, and illustrate the ways in which these challenges were encountered in two clinical trials assessing anticoagulant therapy in children with thrombophilia (PROTEKT (PROphylaxis of ThromboEmbolism in Kids Trial) and REVIVE (REVIparin in Venous ThromboEmbolism)). Means for overcoming these challenges are also addressed.
Collapse
Affiliation(s)
- M Patricia Massicotte
- Paediatric Thrombosis, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | |
Collapse
|
49
|
Affiliation(s)
- David B Matchar
- Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC 27705, USA.
| | | |
Collapse
|