A pediatric institutional acute stroke protocol improves timely access to stroke treatment

Aim We aimed to evaluate whether an institutional acute stroke protocol (ASP) could accelerate the diagnosis and secondary treatment of pediatric stroke. Method We initiated an ASP in 2005. We compared 209 children (125 males, 84 females; median age 4.8y, interquartile range [IQR] 1.2–9.3y, range 0....

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Published in:Developmental medicine and child neurology 2017-01, Vol.59 (1), p.31-37
Main Authors: Shack, Melissa, Andrade, Andrea, Shah‐Basak, Priyanka P, Shroff, Manohar, Moharir, Mahendranath, Yau, Ivanna, Askalan, Rand, MacGregor, Daune, Rafay, Mubeen F, deVeber, Gabrielle A, Surmava, Ann‐Marie, Paterson, Julie
Format: Article
Language:English
Subjects:
Brain Ischemia - complications
Child
Child, Preschool
Cohort Studies
Databases, Factual - statistics & numerical data
Early Diagnosis
Female
Fibrinolytic Agents - therapeutic use
Hospitalization
Humans
Infant
Male
Neuroimaging - methods
Outcome Assessment (Health Care)
Stroke - diagnosis
Stroke - etiology
Stroke - therapy
Time Factors
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Summary:Aim We aimed to evaluate whether an institutional acute stroke protocol (ASP) could accelerate the diagnosis and secondary treatment of pediatric stroke. Method We initiated an ASP in 2005. We compared 209 children (125 males, 84 females; median age 4.8y, interquartile range [IQR] 1.2–9.3y, range 0.09–17.7y) diagnosed with arterial ischemic stroke ‘pre‐protocol’ (1992–2004) to 112 children (60 males, 52 females; median age 5.8y, IQR 1.0–11.4y, range 0.08–17.7y) diagnosed ‘post‐protocol’ (2005–2012) for time‐to‐diagnosis, mode of diagnostic imaging, and time‐to‐treatment with antithrombotic medication (aspirin or anticoagulants). Results Overall, the interval from symptom onset to diagnosis was similar post‐protocol compared to pre‐protocol (20.3 vs 22.7h; p=0.109), although mild strokes (Pediatric National Institute of Health Stroke Scale [PedNIHSS] 0–4), were diagnosed faster post‐protocol (12.1 vs 36.3h; p=0.003). Magnetic resonance imaging (MRI) was the initial diagnostic modality more often post‐protocol (25% vs 1.4%; p
ISSN:0012-1622
1469-8749
DOI:10.1111/dmcn.13214