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Updated: May 28, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Delayed diagnosis of acute ischemic stroke in children - a registry-based study in Switzerland
Charlotte Martin1, Erik von Elm, Marwan El-Koussy
1University of Zurich, Switzerland.
Insights
Early diagnosis of pediatric arterial ischemic stroke (AIS) is crucial. Delays in diagnosing childhood AIS are often due to poor symptom recognition by caregivers and healthcare professionals, impacting treatment access.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Public Health
Background:
- Arterial ischemic stroke (AIS) in children requires prompt diagnosis to enable timely interventions.
- Pediatric AIS diagnosis often exceeds the 6-hour window for thrombolysis available to adults.
- Investigating diagnostic delays in pediatric AIS is critical for improving patient outcomes.
Purpose of the Study:
- To investigate the time to diagnosis for pediatric arterial ischemic stroke (AIS).
- To identify factors contributing to diagnostic delays in children with AIS.
- To inform strategies for improving the recognition and diagnosis of stroke in pediatric patients.
Main Methods:
- Analysis of data from the Swiss Neuropaediatric Stroke Registry (2000-2006) for children under 16 with AIS.
- Evaluation of the time from initial medical evaluation to AIS diagnosis.
- Assessment of risk factors, comorbidities, and imaging findings associated with diagnostic delays.
Main Results:
- Out of 91 children with AIS, only 35% were diagnosed within 6 hours.
- Delays were primarily attributed to insufficient recognition of stroke symptoms by parents/caregivers (20 cases) and healthcare providers (5+8 cases).
- Comorbidities hindered timely diagnosis in 8 children; no other factors were significantly associated with delays.
Conclusions:
- One-third of pediatric AIS cases were diagnosed within the critical 6-hour window.
- The primary cause of diagnostic delay is the inadequate recognition of stroke symptoms in children.
- Enhancing public and professional awareness, alongside immediate access to diagnostic imaging, is essential for improving pediatric AIS diagnosis.
Questions Under Study/Principles:
After arterial ischemic stroke (AIS) an early diagnosis helps preserve treatment options that are no longer available later. Paediatric AIS is difficult to diagnose and often the time to diagnosis exceeds the time window of 6 hours defined for thrombolysis in adults. We investigated the delay from the onset of symptoms to AIS diagnosis in children and potential contributing factors.
Methods:
We included children with AIS below 16 years from the population-based Swiss Neuropaediatric Stroke Registry (2000-2006). We evaluated the time between initial medical evaluation for stroke signs/symptoms and diagnosis, risk factors, co-morbidities and imaging findings.
Results:
A total of 91 children (61 boys), with a median age of 5.3 years (range: 0.2-16.2), were included. The time to diagnosis (by neuro-imaging) was <6 hours in 32 (35%), 6-12 hours in 23 (25%), 12-24 hours in 15 (16%) and >24 hours in 21 (23%) children. Of 74 children not hospitalised when the stroke occurred, 42% had adequate outpatient management. Delays in diagnosis were attributed to: parents/caregivers (n = 20), physicians of first referral (n = 5) and tertiary care hospitals (n = 8). A co-morbidity hindered timely diagnosis in eight children. No other factors were associated with delay to diagnosis. A total of 17 children were inpatients at AIS onset.
Conclusions:
One-third of children with AIS were diagnosed within six hours. Diagnostic delay was predominately caused by insufficient recognition of stroke symptoms. Increased public and expert awareness and immediate access to diagnostic imaging are essential. The ability of parents/caregivers and health professionals to recognise stroke symptoms in a child needs to be improved.
