title: Cerebral oximetry with cerebral blood volume index in detecting pediatric stroke in a pediatric ED.
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 (rcso2) 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.
  
  
  METHODS
  Left rcso2, right rcso2, and rcso2 side differences for stroke, location, and types were analyzed.
  
  
  RESULTS
  Compared with stroke alert (n = 25) and overall strokes (n = 52), rcso2 and CBVI were less than those in nonstrokes (n = 133; P < .0001). Rcso2 side differences in stroke alert and overall strokes were greater than in nonstrokes (P < .0001). Lower rcso2 and CBVI correlated with both groups' stroke location, left (P < .0001) and right rcso2 (P = .004). Rcso2 differences greater than 10 had a 100% positive predictive value for stroke. Both groups' rcso2 and CBVI side differences were consistent for stroke location and type (P < .0001). For both groups, left rcso2 and CBVI were greater than those of the right (P < .0001). Hemorrhagic strokes had lower bilateral rcso2 and CBVI than did ischemic strokes (P < .001).
  
  
  CONCLUSIONS
  Cerebral oximetry and CBVI detected abnormal cerebral physiology, stroke location, and type (hemorrhagic or ischemic). Rcso2 side differences greater than 10 or rcso2 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 rcso2 side difference greater than 10 or one or both sides having less than 50% rcso2 readings suggests abnormal hemispheric pathology and expedites the patient's diagnosis, neuroresuscitation, and radiologic imaging.
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR. Electronic address: tjabramo@uams.edu.
authors: Thomas J
authors: TJ
authors: Abramo
authors: Department of Pediatrics, Division of Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Z Leah
authors: ZL
authors: Harris
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Tennessee, Memphis, TN.
authors: Mark
authors: M
authors: Meredith
authors: Vanderbilt University Medical Center, Vanderbilt School of Medicine, Nashville, TN.
authors: Kristen
authors: K
authors: Crossman
authors: UAMS Department of Emergency Medicine, Little Rock, AR.
authors: Rawle
authors: R
authors: Seupaul
authors: Pediatric Emergency Medicine Associates, Atlanta, GA.
authors: Abby
authors: A
authors: Williams
authors: Vanderbilt University Medical Center, Vanderbilt School of Medicine, Nashville, TN.
authors: Sheila
authors: S
authors: McMorrow
authors: Vanderbilt School of Nursing, Nashville, TN.
authors: Jennifer
authors: J
authors: Dindo
authors: Vanderbilt School of Nursing, Nashville, TN.
authors: Angela
authors: A
authors: Gordon
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR.
authors: Maria
authors: M
authors: Melguizo-Castro
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR.
authors: Zhuopei
authors: Z
authors: Hu
authors: Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Arkansas School of Medicine, Arkansas Children's Hospital, Little Rock, AR.
authors: Todd
authors: T
authors: Nick
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D001810:Blood Volume; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000378:metabolism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D010100:Oxygen