BALTIMORE — Stroke tools designed for adult patients are not sensitive or specific in diagnosing ischemic stroke in children, according to a study presented at the American Neurological Association 2014 Annual Meeting.

Lead researcher Kerri Gramling, MD, and colleagues found that an adult stroke tool developed by the Central Ohio Trauma System (COTS) was not adequate in diagnosing childhood stroke.

Previous uncontrolled studies of childhood strokes have suggested that stroke tools used for adults can also be used for children.The researchers sought to determine whether these adult tools are sensitive and specific for childhood ischemic stroke.

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The COTS stroke tool includes consciousness, slurred speech, facial droop, and hemiparesis. The study included children with radiologically confirmed stroke at Nationwide Children’s Hospital from 2006 to 2013. Controls were children seen in the ED for hemiplagia or facial weakness not due to stroke.

In all, the study consisted of 59 cases and 57 controls. Physical findings were scored using the COTS tool, with a score of ≥3 being positive for stroke. The researchers found that Chi square analysis showed no differences (2.071, P=50.150).

Receiver operator curves revealed low sensitivity and specificity for the COTS tool (area under the curve = 50.526), with an effect size of 0.134.

These results indicate that adult tools cannot be used for children. Different tools are needed to account for development-dependant functions and the frequency of seizures as a first sign of stroke in children, the researchers concluded.


  1. Gramling, K. Abstract #S904 “Sensitivity and Specificity of an Adult Stroke Tool in Childhood Ischemic Stroke” Presented at: American Neurological Association 2014 Annual Meeting. October 12-14, 2014; Baltimore.