In Development
Genetics and Pediatric Stroke (GAPS)
Principal Investigators: Steven Kittner, Braxton Mitchell, Heather Fullerton
The purpose of GAPS is to determine if there are genetic reasons for why some children are more likely to have a stroke than others. In this study, childhood stroke survivors and their parents will provide blood samples for whole genome sequencing.
acutE Perfusion Imaging in Childhood LVO (EPIC-LVO): A Prospective Neuroimaging Pilot Study
PI: Sarah Lee
The primary aim of EPIC-LVO is is to prospectively assess the feasibility and acceptability of performing hyperacute MRI perfusion imaging in children. Outcome measures will include the proportion of patients who successfully undergo perfusion imaging, as well as a descriptive analysis of provider perceptions of barriers to and utility of perfusion imaging acquisition. Secondary aim #1 is to assess perfusion parameters that best correlate with core and penumbra in children with large vessel occlusion; secondary aim #2 is to compare perfusion and collateral profiles in children with cardioembolic, arteriopathic, and cryptogenic stroke.
The results of EPIC-LVO will provide critical feasibility data in support of a larger prospective, multi-center study determining core and penumbral thresholds in children, with the ultimate goal of determining selection criteria for hyperacute reperfusion therapy in pediatric patients.
Active
International Pediatric Stroke Study (IPSS)
About
The International Pediatric Stroke Study (IPSS) is the world’s largest and most successful childhood stroke registry and network made up of dedicated clinicians, scientists and research staff from over 100 institutions in 34 countries. They have prospectively enrolled over 6,000 patients in an effort to conduct high-quality clinical and imaging research studies. The IPSS will continue to conduct transformational research with help and support from partner organization IPSO. Together, the IPSS and IPSO will provide the foundation for scientific and clinical collaborations, as well as advocate for the paediatric stroke community worldwide.
Mission
The missions of the IPSS are to:
- Perform international collaborative research aimed at undertanding, preventing, and improving outcomes in pediatric stroke.
- Support the mission of IPSO by serving as a clinical and imaging research network with an attractive platform for sites to enroll patients into a centralized, shared registry database.
- Provide IPSO and the pediatric stroke community with data that can be used to support professional and public education; families with pediatric stroke members; and the development of future research and clinical trials.
Objectives
The main objective of the IPSS is to develop and conduct research to improve the care of children with stroke.
The specific objectives to promote this aim are to:
1. Ascertain in a prospective, consecutive cohort study the numbers of newborns and children with ischemic stroke, their stroke sub-types and risk factors, their current treatments and outcomes within our centers. These data will provide the rationale and feasibility data for our group to design and implement the initial randomized controlled trials (RCTs) in pediatric stroke as well as other fundable grant proposals.
2. Develop standardized data collection forms and an appropriate database with web-based data entry from multiple study sites.
3. Develop standardized guidelines for (1) diagnosis, (2) investigation of risk factors, (3) outcome assessment,(4) antithrombotic therapies for neonates and children with arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) and (5) partner with other relevant networks caring for stroke
4. Obtain funding to support and conduct additional multi-centre IPSS sub-studies
Studies
Several studies fall under the IPSS framework. IPSS sub-studies include:
- Vascular Effects of Infection in Pediatric Stroke (VIPS) I and II
- Seizures in Pediatric Stroke (SIPS) I and II
- PTSD, Anxiety and Depression in Parents and Children with PAIS (PIPS)
- Parental Outcome following Perinatal Stroke Study (POPS)
Fast Assessment and Stroke Triage in KIDS (FAST-Kids)
PI: Rachel Pearson
The goal of the FAST-Kids Study is to improve the rapid detection of strokes in children through a quality improvement (QI) intervention at the level of pre-hospital emergency medical services (EMS) and the emergency department (ED). We hypothesize that the implementation of a process-of-care for children with focal neurological deficits based on published barriers and enablers to rapid pediatric stroke diagnosis will reduce the time to first brain imaging and other metrics of improved pediatric stroke detection. This prospective cohort study is set within Los Angeles County, which has a single Local EMS Agency, which oversees a system of care serving a population of approximately 10.2 million. We are collecting two years of prospective data to establish baseline metrics before introducing the process-of-care. The study aims are listed below:
1. To determine the baseline frequency of and time to first brain imaging among children (1-14 years of age) in LA County with an EMS activation for an acute onset focal neurological deficit.
a. To determine predictors of shorter time to first brain imaging. Predictor variables include patient-level factors (e.g., demographics, socio-economic status, type of neurological symptoms, distance to ED) and hospital-level factors (e.g., ED or hospital guidelines for focal neurological deficits or stroke in children; availability of a pediatric neurologist, vascular neurologist, or neuro-interventional radiologist)
b. To determine time to first brain imaging demonstrating stroke within the subset of children found to have an acute ischemic or hemorrhagic stroke as the cause for their focal neurological deficit.
2. To determine whether the implementation of a pre-hospital and ED process-of-care for children with focal neurological deficits reduces the time to first brain imaging and other metrics identified in Aim 1.
3. To create and validate a pediatric stroke risk stratification tool that could be used in the pre-hospital setting triage children with focal neurological deficits and high-stroke-risk to pediatric medical centers with EVT capability.
A Prospective Multicenter Registry on Feasibility, Safety, and Outcome of Endovascular Recanalization in Childhood Stroke (Save ChildS Pro)
PI: Peter Sporns
Save ChildS Pro is a worldwide multicenter prospective registry that aims to compare the safety and effectiveness of mechanical thrombectomy (MT) to the best medical care alone (including intravenous thrombolysis) in the treatment of pediatric arterial ischemic stroke (AIS). Patients presenting with AIS from January 1, 2020, will be considered for prospective study enrolment.
Data Analysis
PTSD, Anxiety and Depression in Parents and Children with PAIS (PIPS)
PIPS is a prospective cross-sectional study examining children and their parents 9-31 months from diagnosis of the child's arterial ischemic stroke for chronic symptoms of Post-Traumatic Stress Disorder (PTSD), anxiety, and depression. The purpose of this study is to investigate the association between both child's and parental emotional adjustment with each other and with the child's functional outcome. The study also analyzes the relationship between stroke size and location with child and parental emotional outcomes.
This study used a series of questionnaires to collect information on emotional symptoms and outcomes after stroke (UCLA PTSD Reaction Index, Behavioral Assessment System for Children (BASC-3), PTSD Checklist (PCL-5), the Becks Depression Inventory-II (BDI-II), and Becks Anxiety Inventory (BAI)). Findings are being compared to the location of the stroke as well as the size of the stroke to see if there is an association between the lesion location and emotional outcomes of the child. The Recovery and Recurrence Questionnaire (RRQ) and Pediatric Stroke Outcome Measure (PSOM) were used as well.
Parental Outcome following Perinatal Stroke Study (POPS)
POPS was a longitudinal cohort study of parents of children with neonatal stroke with an educational video intervention. The parents were given access to an online video discussing etiology of perinatal stroke after filling out baseline surveys on their emotional symptoms.
The purpose of this study is to determine the prevalence of Post-Traumatic Stress Disorder (PTSD), anxiety and depression in a large international cohort of parents of children diagnosed with perinatal stroke. The study also aims to determine whether an educational video on etiology of perinatal stroke will decrease parental guilt and blame along with symptoms of PTSD, anxiety, and depression in parents of children recently diagnosed with perinatal stroke.
The study involved having both a pre and post video assessment for guilt and blame as well as symptoms of anxiety, depression, and PTSD. Parents had unlimited use of the video and there was a plan to retest at three months post video release to see if there was a lasting benefit from the video. The study also involved a demographic survey, the Recovery and Recurrence Questionnaire (RRQ), Parental Outcome Measure (POM), Beck’s Anxiety Inventory (BAI), Beck’s Depression Inventory-Second edition (BDI-II) and PTSD Checklist (PCL-5).