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Published on: January 15, 2017
Pediatric Stroke Clinical Pathway Improves the Time to Diagnosis in an Emergency Department
Amy M DeLaroche1, Lalitha Sivaswamy1, Ahmad Farooqi2
1Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Insights
Implementing a pediatric stroke clinical pathway significantly reduced diagnostic times for children with focal neurological dysfunction. This pathway improves the speed of magnetic resonance imaging (MRI) for faster stroke diagnosis in pediatric emergency departments.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Pathway Implementation
Background:
- Delays in provider recognition and neuroimaging hinder pediatric stroke diagnosis.
- Clinical pathways are recommended but their impact is understudied.
- This study evaluates a pediatric stroke clinical pathway's effect on diagnosis.
Purpose of the Study:
- To assess the impact of a pediatric stroke clinical pathway on stroke diagnosis.
- To evaluate the pathway's effect on time to definitive diagnosis in pediatric emergency departments.
Main Methods:
- A pediatric stroke clinical pathway was implemented in a level 1 pediatric emergency department in June 2014.
- Demographic and clinical data were collected for stroke patients before and after pathway implementation.
- Data from patients diagnosed using the pathway were compared to pre-pathway data.
Main Results:
- The pathway was activated for 36 patients; 11 (33%) were diagnosed with stroke.
- Common presentations included focal deficits (82%) and headache (55%).
- Median time to magnetic resonance imaging (MRI) significantly decreased from 17 hours to 4 hours post-implementation (P=0.02).
Conclusions:
- The pediatric stroke clinical pathway improved the time to definitive stroke diagnosis.
- The pathway streamlined care for children with focal neurological dysfunction in the emergency department.
Background:
Identified barriers to the diagnosis of pediatric stroke include delays in provider recognition and definitive neuroimaging (magnetic resonance imaging). Clinical pathways are recommended to address these barriers; yet few studies have evaluated their impact. Our aim is to describe the effect of a pediatric stroke clinical pathway on the diagnosis of stroke in patients presenting with focal neurological dysfunction to a pediatric emergency department.
Methods:
The pediatric stroke clinical pathway was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. Demographic and clinical data were collected for patients ultimately diagnosed with stroke using the pediatric stroke clinical pathway and compared with data collected on patients diagnosed with stroke before implementation of the pediatric stroke clinical pathway.
Results:
The pediatric stroke clinical pathway was activated for 36 patients. Stroke was diagnosed in 11 patients (33%), of whom 55% were male with a median age 11 ± 7 years. Focal deficits (82%) and headache (55%) were common presenting complaints. There was a significant improvement in the median time to magnetic resonance imaging from arrival to the emergency department (before implementation of the pediatric stroke clinical pathway: 17 hours [interquartile range 6, 22] versus after implementation of the pediatric stroke clinical pathway: four hours [interquartile range 3, 12]; P = 0.02).
Conclusions:
The pediatric stroke clinical pathway improved time to definitive diagnosis and streamlined the care provided to children presenting to the pediatric emergency department with focal neurological dysfunction.
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