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Time lag to diagnosis of stroke in children
Lidia V Gabis1, Ravi Yangala, Nicholas J Lenn
1Department of Neurology, State University of New York at Stony Brook, Stony Brook, New York 11794-8790, USA. lgabis@notes.cc.sunysb.edu
Insights
Pediatric stroke diagnosis frequently exceeds the critical 3-6 hour window required for acute treatments like thrombolysis. This delay significantly impacts eligibility for time-sensitive therapies, highlighting a need for increased awareness of childhood stroke symptoms.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Background:
- Childhood stroke is rare, with distinct causes and lifelong disability potential.
- Current acute stroke therapies (thrombolysis, neuroprotection) exclude pediatric patients due to lack of trial data.
- Pediatric stroke diagnosis often misses the narrow therapeutic window.
Observation:
- A study reviewed 41 children (0-18 years) with stroke over two years.
- Diagnosis time from symptom onset averaged 35.7 hours for ischemic and hemorrhagic strokes.
- Only a small fraction of pediatric stroke cases meet the <3-6 hour inclusion criteria for acute treatment trials.
Findings:
- Pediatric stroke diagnosis rarely occurs within the 3-6 hour window crucial for thrombolytic and neuroprotective therapies.
- Delayed diagnosis in children with stroke limits their access to potentially life-altering acute treatments.
- Differences in presentation and treatment options necessitate separate considerations for ischemic and hemorrhagic pediatric strokes.
Implications:
- Increased public and professional awareness of pediatric stroke symptoms is critical.
- Educational efforts should emphasize the importance of rapid diagnosis and treatment for childhood stroke.
- Strategies are needed to improve pediatric stroke recognition and expedite access to time-sensitive interventions.
Objective:
Strokes occur rarely in children, and the causes are different from those in adults. Frequently, more than 1 cause is found. The consequences are lifelong significant disability in a majority of cases. Children who are younger than 18 years have not been included in therapeutic trials of thrombolytic or neuroprotective agents. We evaluated whether children who receive a diagnosis of stroke meet a major inclusion criterion for such trials, namely time to diagnosis of <3 to 6 hours.
Methods:
Prospective documentation and retrospective chart review was conducted of children who were 0 to 18 years and carried a diagnosis of stroke during the last 2 years in the hospital database, including children who presented with either ischemic or hemorrhagic strokes.
Results:
Forty-seven events were encountered in 41 children. Twelve neonates with stroke, diagnosed in the neonatal period, were excluded from the subsequent analysis. In the remaining 29 children, the mean age at presentation was 8.67 years. Accurate time records were available in 24 children. In this group, 28 events were recorded. Time from clinical onset to first medical contact averaged 28.5 hours, and the time to diagnosis of stroke averaged 35.7 hours. We subsequently separated between children with ischemic (21 documented events) and hemorrhagic strokes (7 documented events), because the presentation and the intervention options are different.
Conclusions:
Stroke in children is rarely diagnosed in the time frame of 3 to 6 hours. Given the causes and outcome of stroke in children, this age group might benefit from thrombolysis and from neuroprotective therapy, yet the long delay in diagnosis in this age group excludes most cases from being considered for such treatments. This situation should encourage attempts to increase public and professional awareness of stroke in children and of the potential value of early diagnosis and treatment, preferably by broadening current educational efforts to all age groups.