Related Experiment Video
Updated: Mar 7, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prehospital Emergency Care in Childhood Arterial Ischemic Stroke
Belinda Stojanovski1, Paul T Monagle1, Ian Mosley1
1From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
Insights
Emergency medical services (EMS) have low diagnostic accuracy for childhood arterial ischemic stroke (AIS). Improving EMS recognition and prehospital care is crucial for timely treatment of pediatric stroke.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Stroke Research
Background:
- Timely hospital presentation is critical for adult stroke outcomes.
- Prehospital care and emergency medical services (EMS) protocols for childhood arterial ischemic stroke (AIS) are not well understood.
- This study addresses the knowledge gap in pediatric AIS prehospital care.
Purpose of the Study:
- To evaluate the diagnostic sensitivity of EMS call-takers and paramedics in identifying childhood AIS.
- To describe the timelines of prehospital care for pediatric AIS cases.
- To identify areas for improvement in the emergency response system for pediatric stroke.
Main Methods:
- Retrospective analysis of ambulance-transported children (<18 years) with confirmed first-time AIS.
- Data collected from 2008 to 2015, excluding interhospital transfers.
- Analysis of EMS records, including call-taker and paramedic diagnoses, and prehospital care timelines.
Main Results:
- Nineteen children with confirmed AIS were included in the study.
- EMS call-taker diagnostic sensitivity for stroke was 21%; paramedic sensitivity was 26%.
- Hospital prenotification occurred in 42% of cases, and 68% were transported to primary stroke centers. Total prehospital time averaged 71 minutes.
Conclusions:
- Diagnostic sensitivity for childhood AIS by EMS call-takers and paramedics is low.
- Rates of hospital prenotification are insufficient.
- There is a significant need to enhance EMS recognition and management protocols for pediatric AIS to improve patient outcomes.
Background And Purpose:
Immediately calling an ambulance is the key factor in reducing time to hospital presentation for adult stroke. Little is known about prehospital care in childhood arterial ischemic stroke (AIS). We aimed to determine emergency medical services call-taker and paramedic diagnostic sensitivity and to describe timelines of care in childhood AIS.
Methods:
This is a retrospective study of ambulance-transported children aged <18 years with first radiologically confirmed AIS, from 2008 to 2015. Interhospital transfers of children with preexisting AIS diagnosis were excluded.
Results:
Twenty-three children were identified; 4 with unavailable ambulance records were excluded. Nineteen children were included in the study. Median age was 8 years (interquartile range, 3-14); median Pediatric National Institutes of Stroke Severity Scale score was 8 (interquartile range, 3-16). Emergency medical services call-taker diagnosis was stroke in 4 children (21%). Priority code 1 (lights and sirens) ambulances were dispatched for 13 children (68%). Paramedic diagnosis was stroke in 5 children (26%), hospital prenotification occurred in 8 children (42%), and 13 children (68%) were transported to primary stroke centers. Median prehospital timelines were onset to emergency medical services contact 13 minutes, call to scene 12 minutes, time at scene 14 minutes, transport time 43 minutes, and total prehospital time 71 minutes (interquartile range, 60-85).
Conclusions:
Emergency medical services call-taker and paramedic diagnostic sensitivity and prenotification rates are low in childhood AIS.
More Related Videos
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Cardiopulmonary Resuscitation I: Adult
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:23Cardiopulmonary Resuscitation III: AED Use