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Pediatric Stroke and Its Mimics: Limitations of a Pediatric Stroke Clinical Pathway

Amy M DeLaroche1, Lalitha Sivaswamy2, Ahmad Farooqi3

  • 1Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.

Pediatric Neurology
|February 13, 2018
PubMed

Insights

Pediatric stroke protocols expedite care but do not reliably distinguish stroke from mimics. Further research is needed to develop a reliable pediatric stroke screening tool.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine

Background:

  • Acute stroke protocols aim to improve care delivery for pediatric stroke.
  • It remains unclear if these protocols can differentiate stroke from stroke mimics in children.

Purpose of the Study:

  • To describe institutional experience with stroke mimics identified via the Pediatric Stroke Clinical Pathway (PSCP).

Main Methods:

  • The PSCP was implemented in a Level 1 pediatric emergency department for children aged 1 month to 18 years.
  • Demographic and clinical data were compared for patients diagnosed with stroke versus stroke mimics between June 2014 and December 2016.

Main Results:

  • Of 59 children evaluated, 14 had stroke and 45 had stroke mimics.
  • Common mimics included functional neurological disorders, transient neurological deficits, migraine, and seizure.
  • Vomiting was more common in stroke patients, but demographics and neuroimaging times did not differ; physical examination findings were similar.

Conclusions:

  • The PSCP ensures timely evaluation but does not reliably differentiate pediatric stroke from mimics.
  • Multicentered studies are required to develop a "stroke screen" for accurate differentiation.
Abstract

Keywords:
clinical pathwaypediatricsstrokestroke mimic

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