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J Pediatr. 2019 Nov 5. pii: S0022-3476(19)31189-8. doi: 10.1016/j.jpeds.2019.09.027. [Epub ahead of print]

A Stroke Alert Protocol Decreases the Time to Diagnosis of Brain Attack Symptoms in a Pediatric Emergency Department.

Author information

1
Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA. Electronic address: dharrar@childrensnational.org.
2
Department of Neurology, Boston Children's Hospital, Boston, MA.
3
Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA.
4
Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
5
Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
6
Department of Neurology, Boston Children's Hospital, Boston, MA; Stroke and Cerebrovascular Center, Boston Children's Hospital, Boston, MA; Department of Radiology, Boston Children's Hospital, Boston, MA; Department of Psychiatry, Boston Children's Hospital, Boston, MA.

Abstract

OBJECTIVE:

To determine whether a stroke alert system decreases the time to diagnosis of children presenting to the emergency department (ED) with acute-onset focal neurologic deficits.

STUDY DESIGN:

We performed a retrospective comparison of clinical and demographic information for patients who presented to the ED of a tertiary children's hospital with acute-onset focal neurologic deficits during the 2.5 years before (n = 14) and after (n = 65) the implementation of a stroke alert system. The primary outcome was the median time to neuroimaging analyzed using a Wilcoxon rank-sum test.

RESULTS:

The median time from ED arrival to neuroimaging for patients with acute-onset focal neurologic deficits decreased significantly after implementation of a stroke alert system (196 minutes; IQR, 85-230 minutes before [n = 14] vs 82 minutes; IQR, 54-123 minutes after [n = 65]; P < .01). Potential intravenous tissue plasminogen activator candidates experienced the shortest time to neuroimaging after implementation of a stroke alert system (54 minutes; IQR, 34-66 minutes [n = 13] for intravenous tissue plasminogen activator candidates vs 89.5 minutes; IQR, 62-126.5 minutes [n = 52] for non-intravenous tissue plasminogen activator candidates; P < .01).

CONCLUSIONS:

A stroke alert system decreases the median time to diagnosis by neuroimaging of children presenting to the ED with acute-onset focal neurologic deficits by more than one-half. Such a protocol constitutes an important step in ensuring that a greater proportion of children with arterial ischemic stroke are diagnosed in a time frame that enables hyperacute treatment.

KEYWORDS:

acute-onset focal neurologic deficit; intravenous tissue plasminogen activator (IV-tPA); mechanical thrombectomy; pediatric arterial ischemic stroke; pediatric code stroke; pediatric stroke; pediatric stroke stat

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