Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED

Thomas J. Abramo*, Z. Leah Harris, Mark Meredith, Kristen Crossman, Rawle Seupaul, Abby Williams, Sheila McMorrow, Jennifer Dindo, Angela Gordon, Maria Melguizo-Castro, Zhuopei Hu, Todd Nick

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Background Despite pediatric stroke awareness and pediatric stroke activation systems, recognition and imaging delays along with activation inconsistency still occur. Reliable objective pediatric stroke detection tools are needed to improve detection and activations. Regional cerebral oxygen saturation (rc so 2) with cerebral blood volume index (CBVI) can detect abnormal cerebral physiology. Objective To determine cerebral oximetry in detecting strokes in stroke alert and overall stroke patients. Method Left rc so 2, right rc so 2, and rc so 2 side differences for stroke, location, and types were analyzed. Results Compared with stroke alert (n = 25) and overall strokes (n = 52), rc so 2 and CBVI were less than those in nonstrokes (n = 133; P <.0001). Rc so 2 side differences in stroke alert and overall strokes were greater than in nonstrokes (P <.0001). Lower rc so 2 and CBVI correlated with both groups' stroke location, left (P <.0001) and right rc so 2 (P =.004). Rc so 2 differences greater than 10 had a 100% positive predictive value for stroke. Both groups' rc so 2 and CBVI side differences were consistent for stroke location and type (P <.0001). For both groups, left rc so 2 and CBVI were greater than those of the right (P <.0001). Hemorrhagic strokes had lower bilateral rc so 2 and CBVI than did ischemic strokes (P <.001). Conclusions Cerebral oximetry and CBVI detected abnormal cerebral physiology, stroke location, and type (hemorrhagic or ischemic). Rc so 2 side differences greater than 10 or rc so 2 readings less than 50% had a 100% positive predictive value for stroke. Cerebral oximetry has shown potential as a detection tool for stroke location and type in a pediatric stroke alert and nonalert stroke patients. Using cerebral oximetry by the nonneurologist, we found that the patient's rc so 2 side difference greater than 10 or one or both sides having less than 50% rc so 2 readings suggests abnormal hemispheric pathology and expedites the patient's diagnosis, neuroresuscitation, and radiologic imaging.

Original languageEnglish (US)
Pages (from-to)1622-1629
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number11
DOIs
StatePublished - Jun 25 2015

ASJC Scopus subject areas

  • Emergency Medicine

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