Pediatric Stroke Outcome Measure

Posted on: March 15, 2015 | By: jmoore44 | Filed under: Pediatric Stroke Outcome Measure
  1. Descriptive Information
    1. Title, Edition, Dates of Publication and Revision*
      1. The Pediatric Stroke Outcome Measure (PSOM), 2000
    2. Author (s)
      1. Gabrielle A. deVeber, MD; Duane MacGregor, MD; Rosalind Curtis, MD
    3. Source (publisher or distributor, address)
      1. The PSOM and instructions are available by contacting the senior author Gabrielle A deVeber, MD at gabrielle.deveber@sickkids.ca
    4. Costs (booklets, forms, kit)*
      1. Information is not publicly available, must contact lead author
    5. Purpose*
      1. To develop an objective, disease specific outcome measure suitable for use in the pediatric population that measure neurological deficit and function.
    6. Type of Test (eg, screening, evaluative; interview, observation, checklist or inventory)*
      1. A questionnaire to gather information about initial stroke, past medical history, outcome (current health status), radiographic information, and medications.
      2. A neurologic exam consisting of 115 items is also conducted to gather functional information. The test items are organized developmentally regarding behavior, mental status, cranial nerves, motor function, sensory function, cerebellar function and gait function. The motor function encompasses developmental, gross, and fine motor movements as well as motor tone, power, reflexes and involuntary movements.
    7. Target Population and Ages*
      1. Newborn -18
    8. Time Requirements  – Administration and Scoring*
      1. 20 minutes to Administer and Score (varies depending on the results of the 115 testable items)
  1. Test Administration
    1. Administration 
      1. Administered by a Qualified Professional
    2. Scoring
      1. Based on the results of this examination the individuals deficits are categorized in 5 different domains: sensorimotor R, sensorimotor L, Language Production, Language Comprehension as well as Cognitive and Behavior.
      2. The patients abilities are rated from 0-2 [Normal-0, Mild 0.5, Moderate 1.0, Severe 2.0]
      3. These categories are then added with maximal impairment =10.
    3. Type of information, resulting from testing (e.g. standard scores, percentile ranks)
      1. Categorical Ranking indicating the level of impairment
    4. Environment for Testing
      1. In an examination room or while looking at a patient’s chart
    5. Equipment and Materials Needed 
      1. Not specified in public data. Must contact lead author for specific protocol and instructions.
    6. Examiner Qualifications 
      1. Not specified, but was developed by neurologists
    7. Psychometric Characteristics*
      1. There are no reported MDC/MCIDs
    8. Standardization/normative data
      1. There is none available
    9. Evidence of Reliability
      1. Kittchen, L et al. The Pediatric Stroke outcome Measure: A Validation and Reliability Study. Stroke. 2012; 43:1602-1608.
        1. Prospective and Retrospective IRR were assessed. There was a very good prospective IRR intraclass correlation coefficient of 0.93 with a 95% CI and a moderate-strong retrospective IRR intraclass correlation coefficient of 0.77 with a 95% CI.
    10. Evidence of Validity
      1. Kittchen, L et al. The Pediatric Stroke outcome Measure: A Validation and Reliability Study. Stroke. 2012; 43:1602-1608.
        1. Each of the 5 subscales of the PSOM was matched to a neuropsychological measure in the same functional domain. The neuropsychological measures used were the grooved pegboard, the Wechler Intelligence Scale for Children (WISC), the Wechler Adult Intelligence Scale (WAIS), the Peabody Picture Vocabulary Test (PPVT), the Expressive Vocabulary Test (EVT), Adaptive Behavior Assessment System 2nd edition (ABAS-II) and the Behavior Rating Inventory of Executive Function (BRIEF).
        2. Good construct validity was determined ranging from 0.2-0.4 with a P < 0.05.
    11. Discriminative
      1. The test  described above demonstrates the ability to categorize a patients functional impairment in 5 domains as either Normal (0), Mild(0.5), Moderate (1.0) or Severe (2.0).
    12. Predictive
      1. Further research must be done to determine any correlation between diagnosed severity and long term prognosis.
  1. Summary Comments*
    1. Strengths
      1. This is a very valid and reliable tool that has been compared to many neuropsychological tools. The validity illustrates that you can be confident that you are testing the material that you wish to test and the high reliability gives you confidence to trust the results.
    2. Weaknesses
      1. There is very little information about this outcome tool that is easily accessible. It does not have a website like many measures, rather the lead author must be contacted if a person is interested in utilizing the measure. They will then be given any instructions about how to implement the tool.
    3. Clinical Applications
      1. This tool could be very beneficial in determining the exact domains of functional impairment. The tool can be used to help focus intervention and determine a plan as well record a baseline of functional impairment/severity of the stroke for your patient.

Resources

Kittchen L, et al. The Pediatric Stroke outcome Measure: A Validation and Reliability Study. Stroke. 2012; 43:1602-1608.

deVeber G, MacGregor D, Curtis R.  Mayank S.  Neurologic Outcome in Survivors of Childhood Arterial Ischemic Stroke and Sinovenous Thrombosis. J Child Neuro.  2000; 15(5): 316-324.

Article Summary:

Englemann K, Outcome Measures Utilized in Pediatric Stroke Studies – A Systematic Review. Jordan L. Arch Neurol. 2012 Jan; 69(1): 23–27.

This is a meta analysis that reviewed 34 articles. In order to be included the study had to use at least one outcome measure on participants who had had an ischemic or hemorrhagic stroke and were between the ages of newborn to 18 years old. There were a total of 38 different outcome measures used and the Wechsler Intelligence Scales, Pediatric Stroke Outcome Measure, and Bayley Scales of Infant Development were the most commonly used. the goal of this meta analysis was to maximize comparability of the result of future clinical trials and foster agreement regarding the preferred pediatric outcome measures. The particular characteristics that were focused on were the reliability, responsiveness to change and the validity for use in the pediatric stroke population.

The Pediatric stroke outcome measure was used in 7 of the included studies with an interrater reliability of 91% and had construct validity for use in the pediatric stroke population. It was the only measure included in the article that had this evidence and according to the authors is currently the most appropriate for use in this population as it offers a large amount of information and has research supporting its use. The authors ended their  discussion with a  call for more research to establish a gold standard measure for this population to strength the results of further research.

 

3 responses to “Pediatric Stroke Outcome Measure”

  1. akuzbary says:
    March 15, 2015 at 8:46 pm

    This is a very interesting outcome measure. It is unfortunate that it isn’t easily accessible. It sounds like the kind of outcome measure you would want if you worked with this population of patients. Very well organized presentation of information. Great work.

  2. pcopeland says:
    March 15, 2015 at 8:54 pm

    This tool could be very useful during my inpatient clinical if it is available. The test takes cognitive and functional ability into account, doesn’t take very long to administer, and is valid. Im curious as to why the author hasn’t made more information available about the test and how commonly this test is used in the clinic.

  3. gpulliam says:
    March 15, 2015 at 8:58 pm

    I think you did a really good job with reviewing this outcome measure. It seems like 20 minutes to administer something that has 115 items seems a little bit too good to be true and still accurately depict the patient, but I guess that is explained in the directions that are sent after contacting the author. I understand the importance of copyrighting and protecting one’s work, but it can most definitely be a barrier to efficient use toward the intended purpose sometimes. How do you know that it is the best tool to use for you if you don’t have proper access to it for reviewing purposes? I guess that is where being a consumer of research comes in :).

Leave a Reply