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Comment & Response |

Factors Associated With Neurological Outcome After Childhood Stroke ONLINE FIRST

En Lin Goh, BSc1; Prasanthi Sivakumaran, BSc1
[+] Author Affiliations
1School of Medicine, Imperial College London, London, England
JAMA Neurol. Published online August 22, 2016. doi:10.1001/jamaneurol.2016.2951
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To the Editor We thank Grelli et al1 for their study investigating the factors associated with neurological outcome following childhood stroke. The authors1 reported an association between hyperglycemia and poor neurological outcome in their cohort.

However, we feel that it may be premature to discard the utility of hypertension as a prognostic and potentially modifiable marker of neurological outcome, given that the results are contrary to previous work.2 Although both systolic and diastolic blood pressure (BP) were adjusted for age, sex, and height in this study, 36% of children (35 of 98) had no documentation of height in their medical records and were placed in the 50th percentile. Given that small differences in height can have a significant influence on the BP percentile, it is unclear how the BP measurements may have been affected by the missing data.3 Furthermore, 39% of the population (38 of 98) met the second definition for hypertension as well as the definition for hypotension used in the study.1 While BP variability was not associated with poor outcome or death, there is no specific mention of when BP measurements were obtained during the first 5 days. As such, this study may have overlooked a potential time window in which hypertension may be of reliable prognostic value. Hence, future studies assessing BP at specific points following stroke are required to shed more light on the nature of this association.

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August 22, 2016
Kimberly N. Grelli, MD; Melissa C. Gindville, MS; Lori C. Jordan, MD, PhD
1Department of Pediatrics, University of Washington, Seattle2Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
2Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Neurol. Published online August 22, 2016.;():. doi:10.1001/jamaneurol.2016.2934.
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