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J Pediatr. 2020 Mar 5. pii: S0022-3476(20)30140-2. doi: 10.1016/j.jpeds.2020.01.067. [Epub ahead of print]

Pediatric Acute Stroke Protocol Implementation and Utilization Over 7 Years.

Author information

1
Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
2
Department of Pediatrics, University of Colorado, Aurora, CO; Department of Neurology, University of Colorado, Aurora, CO.
3
Meharry Medical College, Nashville, TN.
4
Department of Neurosurgery, Icahn School of Medicine at Mt Sinai, New York, NY.
5
Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN. Electronic address: lori.jordan@vanderbilt.edu.

Abstract

OBJECTIVE:

To examine the implementation and utilization of a pediatric acute stroke protocol over a 7-year period, hypothesizing improvements in protocol implementation and increased protocol use over time.

STUDY DESIGN:

Clinical and demographic data for this retrospective observational study from 2011 through 2018 were obtained from a quality improvement database and medical records of children for whom the acute stroke protocol was activated. The initial 43 months of the protocol (period 1) were compared with the subsequent 43 months (period 2).

RESULTS:

Over the 7-year period, a total of 385 stroke alerts were activated, in 150 children (39%) in period 1 and 235 (61%) in period 2, representing a 56% increase in protocol activation. Stroke was the final diagnosis in 80 children overall (21%), including 38 (25%) in period 1 and 42 (19%) in period 2 (P = .078). The combined frequency of diagnosed stroke, transient ischemic attack (TIA), and other neurologic emergencies remained stable across the 2 time periods at 39% and 37%, respectively (P = .745). Pediatric National Institutes of Health Stroke Scale (PedNIHSS) documentation increased from 42% in period 1 to 82% in period 2 (P < .001). Magnetic resonance imaging (MRI) was the first neuroimaging study for 68% of the children in period 1 vs 78% in period 2 (P = .038). All children with acute stroke received immediate supportive care.

CONCLUSIONS:

Pediatric stroke protocol implementation improved over time with increased use of the PedNIHSS and use of MRI as the first imaging study. However, with increased utilization, the frequency of confirmed strokes and other neurologic emergencies remained stable. The frequency of stroke and other neurologic emergencies in these children affirms the importance of implementing and maintaining a pediatric acute stroke protocol.

KEYWORDS:

hemorrhage; ischemic stroke; pediatric stroke

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