Acute Stroke Protocol Speeds Diagnosis in Children

Researchers at Vanderbilt University Medical Center (VUMC; Nashville, TN, USA) conducted a study to examine the efficacy of a pediatric acute stroke protocol implemented at the VUMC ED between April 2011 and October 2014, which required a neurology resident to evaluate all children presenting with stroke symptoms within 15 minutes. Urgent magnetic resonance imaging (MRI) and computerized tomography (CT) were available on site. Clinical and demographic information was obtained from a quality improvement database for all patients under 20 years of age that presented at the ED.

The results showed that of the 124 stroke alerts, 30 were confirmed as stroke, and another two children suffered a transient ischemic attack (TIA); 37% of the cases were in healthy children without any significant prior medical history. Non-stroke neurological emergencies were encountered in 17 children, including meningitis, encephalitis, intracranial neoplasm, complex migraine, and seizure. The median time from ED arrival to MRI was 94 minutes, and the median time to CT was 59 minutes. The study was published on July 2, 2015, in Stroke.

“Just as there are rapid response processes for adults with a possible stroke, there should be a rapid response process for children with a possible stroke that includes expedited evaluation and imaging, or rapid transfer to a medical center with pediatric stroke expertise,” said senior author Lori Jordan, MD, PhD. “We need the emergency department, radiology, critical care medicine, and often many other specialists to work quickly and efficiently together to treat pediatric patients.”

Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under- or misdiagnosed, due to risk factors that are less common than in adults and a clinical presentation that varies based on the child's age. While management strategies in children are extrapolated primarily from adult care, different factors are taken into consideration regarding short-term anticoagulation and thrombolytic therapies.

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