Delayed recognition of initial stroke in children: need for increased awareness

Area of Science:

• Pediatric Neurology
• Neuroscience
• Medical Diagnostics

Background:

• Pediatric arterial ischemic stroke (AIS) is a critical cause of childhood morbidity and mortality.
• Timely diagnosis of AIS is essential for effective management and improved outcomes in children.
• Understanding diagnostic delays is crucial for developing strategies to improve pediatric stroke care.

Purpose of the Study:

• To investigate and quantify the diagnostic delays associated with pediatric arterial ischemic stroke (AIS).
• To identify factors contributing to the time from clinical onset to diagnosis of AIS in neonates and children.
• To highlight potential areas for improvement in the recognition and diagnosis of pediatric stroke.

Main Methods:

• Retrospective analysis of neonates (<=28 days) and children with radiologically confirmed first-time AIS (June 1993 - January 2006).
• Calculation of the time to AIS diagnosis (clinical onset to radiologic confirmation).
• Review of factors influencing stroke diagnosis, including patient characteristics and physician documentation.

Main Results:

• Median time to AIS diagnosis was significantly longer in neonates (87.9 hours) compared to children (24.8 hours).
• Inpatient status and physician evaluation were associated with quicker diagnosis, yet suspicion of AIS was documented in only 26% of children.
• Presence of seizures or focal neurologic deficits did not correlate with a faster diagnosis time.

Conclusions:

• Significant diagnostic delays in pediatric AIS persist, likely due to a lack of awareness among medical professionals.
• Despite presenting risk factors and focal signs, AIS is often not recognized promptly by healthcare providers.
• Enhanced medical education and diagnostic protocols are needed to reduce delays in pediatric AIS diagnosis.