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Published on: January 18, 2018
Diagnostic delays in paediatric stroke
Andrew A Mallick1, Vijeya Ganesan2, Fenella J Kirkham3
1Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.
Insights
Diagnosing childhood stroke is often delayed, particularly arterial ischemic stroke (AIS). Magnetic resonance imaging (MRI) should be the first choice for imaging suspected AIS to ensure timely diagnosis.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Emergency Medicine
Background:
- Stroke is a significant cause of mortality and severe morbidity in children.
- Conditions mimicking stroke in children require prompt diagnosis and treatment.
- Investigating diagnostic timelines is crucial for improving pediatric stroke care.
Purpose of the Study:
- To investigate the time to diagnosis in a cohort of children experiencing stroke.
- To identify delays in the diagnostic pathway for pediatric stroke.
- To compare diagnostic times between arterial ischemic stroke (AIS) and hemorrhagic stroke (HS).
Main Methods:
- Population-based prospective cohort study of children with stroke in Southern England.
- Review of case notes, hospital admission databases, and radiology records.
- Recording of symptom onset, hospital presentation, neuroimaging times, and clinical features.
Main Results:
- Median time from symptom onset to diagnostic neuroimaging was 24.3 hours for AIS and 2.9 hours for HS.
- CT scans were diagnostic in 66% of AIS cases, while MRI was diagnostic in 100%.
- Delayed neuroimaging in AIS occurred with initial CT scans and presentations outside working hours.
Conclusions:
- Diagnosis of AIS in children is significantly delayed at multiple stages.
- Initial CT scanning, often non-diagnostic for AIS, is a major contributor to diagnostic delays.
- MRI is recommended as the initial imaging modality for suspected childhood AIS.
Background:
Stroke is a major cause of mortality in children. Conditions that mimic stroke also cause severe morbidity and require prompt diagnosis and treatment. We have investigated the time to diagnosis in a cohort of children with stroke.
Methods:
A population-based cohort of children with stroke was prospectively identified in the south of England. Case notes, electronic hospital admission databases and radiology records were reviewed. Timing of symptom onset, presentation to hospital, first neuroimaging, first diagnostic neuroimaging and presenting clinical features were recorded.
Results:
Ninety-six children with an arterial ischaemic stroke (AIS) and 43 with a haemorrhagic stroke (HS) were identified. The median time from symptom onset to diagnostic neuroimaging was 24.3 h in AIS and 2.9 h in HS. The initial imaging modality was CT in 68% of cases of AIS. CT was diagnostic of AIS in 66% of cases. MRI was diagnostic in 100%. If initial neuroimaging was non-diagnostic in AIS, then median time to diagnosis was 44 h. CT was diagnostic in 95% of HS cases. Presentation outside normal working hours resulted in delayed neuroimaging in AIS (13 vs 3 h, p=0.032). Diffuse neurological signs or a Glasgow Coma Scale <9 resulted in more expeditious neuroimaging in both HS and AIS.
Conclusions:
The diagnosis of AIS in children is delayed at every stage of the pathway but most profoundly when the first neuroimaging is CT scanning, which is non-diagnostic. MRI should be the initial imaging modality of choice in any suspected case of childhood AIS.
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