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ED rapid response plan helps diagnose pediatric stroke symptoms
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Among children presenting to the ED of a single center with brain attacks when a pediatric acute stroke protocol was activated, 40% had a stroke or other neurological emergency, according to new findings.
Very few of the children had congenital heart disease or another known cardiac condition, researchers found.
They obtained clinical and demographic information from a quality improvement database and medical records from consecutive patients aged 20 years or younger presenting to the Vanderbilt University’s pediatric ED with a brain attack during activation of an acute stroke protocol between April 2011 and October 2014. The protocol included a neurology resident evaluating the child within 15 minutes and urgent MRI being available.
Lori C. Jordan
“Rapid evaluation and appropriate testing is critical,” Lori C. Jordan, MD, PhD, assistant professor of pediatrics and neurology at Monroe Carell Jr. Children’s Hospital at Vanderbilt and director of the Vanderbilt pediatric stroke program, said in a press release. “Prior studies have suggested that stroke in children often takes a long time to diagnose due to delays in imaging.”
During the stroke period, there were 124 stroke alerts (mean age, 11.2 years; 63 boys), researchers reported. Of those, 40% turned out to be a stroke or other neurological emergency (stroke, 24%; transient ischemic attack, 2%; other neurological emergency, 14%), they wrote.
Of those with stroke or TIA, 16% had a cardiac medical history and 6% had congenital heart disease, the researchers found. This did not significantly differ from those who did not have stroke or TIA; among those children, 11% had a cardiac medical history (P = .48) and 4% had congenital heart disease (P = .67).
In the stroke/TIA group, 19% had a vascular medical history compared with 13% from the non-stroke/TIA group (P = .43), Jordan and colleagues wrote.
Thirty-seven percent of children had no significant medical history. Of those without stroke or neurological emergency, the most common diagnoses were complex migraine (17%) and seizure (15%), Jordan and colleagues found.
MRI was the first study in 76% of cases, and all children but one had urgent neuroimaging, the researchers reported. Median time from ED arrival to MRI was 94 minutes (interquartile range [IQR], 49-151), and median time from ED arrival to CT was 59 minutes (IQR, 40-112). The overall time to first scan of any type was 79 minutes (IQR, 45-422); when outliers longer than 180 minutes were excluded, median time to first scan of any type was 65 minutes (IQR, 41-104).
“A system for emergency evaluation of children with stroke-like symptoms is warranted,” Jordan and colleagues wrote. “Raising awareness of stroke in a children’s medical center can improve the time to stroke diagnosis compared with what is reported in the medical literature.” – by Erik Swain
Disclosure: The researchers report no relevant financial disclosures.
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