Because no gold-standard outcome measure or measures exist to allow comparison of pediatric stroke study outcomes in clinical trials, we designed a systematic review of the literature to survey the current use of pediatric stroke outcome measures.
Studies that used at least 1 standardized measure to assess the outcome of children with ischemic or hemorrhagic stroke, from full-term newborn to age 18 years, were included. Although 34 studies were included, an additional 36 studies could not be included because ad hoc, author-generated outcome measures were used.
Excluding those measures in neuropsychological batteries, 38 unique outcome measures were used. The Wechsler Intelligence Scales, Pediatric Stroke Outcome Measure, and Bayley Scales of Infant Development were among the most used, but 79% of outcome measures were used by no more than 2 studies.
Although many measures used have been validated for use in children with other medical conditions or for adults with stroke, only 1 measure has been specifically validated for use in pediatric ischemic stroke. To maximize comparability of future clinical trial results, agreement regarding a preferred pediatric stroke outcome scale or battery of measures is paramount; these measures should be reliable, responsive to change, and specifically validated for use in children with stroke.
Engelmann, Kyle A. and Lori C. Jordan
Disease Category: Child health, Heart & circulation, Neurology
Disease Name: Stroke
Age Range: 0 - 18
Sex: Either
Nature of Intervention: Not specified
- None
- Systematic review of outcome measures/measurement instruments
- Systematic review
Eligible studies included children from birth to age 18 years with ischemic stroke, hemorrhagic stroke, or both, had more than 5 subjects, and evaluated children for neurological or functional outcome status with a recognized outcome measure. Studies were excluded if the subjects were solely preterm infants, had purely intraventricular hemorrhage, or experienced stroke exclusively due to trauma. Studies with mixed study populations (eg, term and preterm infants with stroke) were included only if data could be separated. Studies using ad hoc or unrecognized outcome measures were excluded, as were review, non-English, nonhuman, and abstract-only studies.
Electronic searches of CINAHL, EMBASE, PubMed, and Web of Science were performed in August 2010 using a combination of all relevant PubMed medical subject heading terms and keywords relating to children, stroke, and outcome measures. Identified studies were imported into a reference manager, and duplicates of identical studies were removed.
Study quality was assessed insofar as each study was screened for clear reporting of methods and data. Information on validity, reliability, and general and psychometric data on standardized outcome measures was retrieved from both the outcome measures’ sources and original studies.