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

J Pediatr. 2020 Jan:216:136-141.e6. doi: 10.1016/j.jpeds.2019.09.027. Epub 2019 Nov 6.

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.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Algorithms
  • Child
  • Child, Preschool
  • Clinical Protocols
  • Decision Trees
  • Early Diagnosis
  • Early Warning Score
  • Emergency Service, Hospital
  • Female
  • Humans
  • Infant
  • Male
  • Neuroimaging
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Stroke / diagnosis*
  • Stroke / diagnostic imaging
  • Young Adult