Pediatric stroke, transient ischemic attack, and non-vascular mimics in the emergency department: a three-group analysis of clinical predictors and diagnostic performance
Brain and Development, cilt.48, sa.6, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 48 Sayı: 6
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.braindev.2026.104615
- Dergi Adı: Brain and Development
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE, Psycinfo, Academic Search Ultimate (EBSCO)
- Anahtar Kelimeler: Differential diagnosis, Emergency department, Focal neurological deficit, Pediatric stroke, Stroke mimics, Transient ischemic attack
- Dokuz Eylül Üniversitesi Adresli: Evet
Özet
Background: Pediatric stroke is a diagnostic challenge due to the high prevalence of stroke mimics in the emergency setting. This study aimed to identify distinguishing clinical features among confirmed stroke, transient ischemic attack (TIA), and non-vascular mimics. Methods: This retrospective cohort enrolled patients aged 1 month–18 years with acute focal neurological deficits presenting to a tertiary pediatric emergency department. Patients were classified into three groups: confirmed stroke, TIA, and non-vascular mimics. Firth penalized logistic regression and receiver operating characteristic (ROC) analysis were performed for each pairwise comparison. Results: Of 103 patients, 25 (24.3%) had confirmed stroke, 24 (23.3%) TIA, and 54 (52.4%) non-vascular mimics. Stroke patients were younger than TIA (median 7.0 vs. 12.5 years; p = 0.002) and non-vascular mimic patients (7.0 vs. 11.0 years; p = 0.007). Symptom duration >48 h, focal seizures, and pathological reflexes were the strongest discriminators between stroke and TIA (all p < 0.05); pathological reflexes were absent in all non-vascular mimic patients. Chronic disease was more prevalent in stroke vs. TIA (48.0% vs. 16.7%; p = 0.032). Firth regression identified age (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.67–0.99; p = 0.036) and symptom duration >48 h (OR 11.12; 95% CI 1.86–66.34; p = 0.008) as independent distinguishing clinical features of stroke vs. TIA. Combined model area under the curve (AUC): 0.898 (stroke vs. TIA) and 0.731 (stroke vs. non-vascular mimics). Routine laboratory parameters did not differ across groups. Conclusion: Age, symptom duration, focal seizures, and pathological reflexes are key discriminators of stroke from TIA. Discriminability is substantially higher when contrasting stroke with TIA (AUC 0.898) than with non-vascular mimics (AUC 0.731), underscoring the value of separating TIA in the analytical framework. Prompt neuroimaging with systematic clinical assessment remains essential for accurate diagnosis.