Abstract TMP85: Hyperacute Pediatric NIH Stroke Scale Does Not Predict 3-month Outcome In Children

Background: The assumption of severity of initial stroke symptoms predicting long-term outcomes is foundational to deciding whether to give hyperacute therapies. The relationship is well-established in adult stroke, however, children often have additional symptoms at presentation, such as altered mental status, which may influence the pediatric NIH stroke scale (PedNIHSS). Prior preliminary work found that PedNIHSS obtained at a median of 28 hours from symptom onset was associated with long-term outcomes. We therefore sought to establish whether the initial hyperacute PedNIHSS, obtained within a possible hyperacute treatment window, correlates with long-term outcomes. Hypothesis: We hypothesized that hyperacute PedNIHSS would correlate with pediatric stroke outcome measure (PSOM) at 3 months. Methods: Multicenter data was prospectively collected and retrospectively reviewed. The hyperacute PedNIHSS was defined as PedNIHSS obtained within 24 hours of symptom onset and time last seen well (TLSW). Data were analyzed using Spearman’s correlation, quantile regression, and ordinal logistic regression. Results: Among a total of 79 children, mean age was 12.7 years and 51% were female. PedNIHSS was obtained 0 to 23.6 hours, median 2.0 hours from symptom onset and/or TLSW. Median PedNIHSS score was 13 [IQR 9-17]. 93% received hyperacute therapies. Three children died within first 3 months. Median PSOM was 1 [IQR 0.5-2.5] at 3 months. Hyperacute NIHSS and PSOM at 3 months were both available in a total of 57 patients. There was no correlation between hyperacute NIHSS and PSOM at 3 months (r=0.27, n=57) ( Figure ). Conclusion: Hyperacute PedNIHSS did not correlate with outcomes in our data. Further work is needed to understand factors influencing initial PedNIHSS and acute management that may confound the relationship between initial assessment and long-term outcome in children with acute ischemic stroke.