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In-Hospital Pediatric Stroke Alert Activation
Megan Barry1, Truc M Le2, Melissa C Gindville3
1Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, Division of Pediatric Neurology, University of Colorado Medical Center, Aurora, Colorado.
Pediatric Neurology
|October 16, 2018
Summary
In-hospital pediatric stroke alerts identified stroke in 45% of children, with other neurological conditions also requiring urgent care. These alerts facilitate rapid evaluation for pediatric neurological emergencies.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Quality Improvement
Background:
- Pediatric stroke alerts (
- code strokes
- ) enable rapid evaluation and treatment for children with stroke symptoms.
- A prior study found 24% of emergency department-initiated alerts confirmed strokes.
Purpose of the Study:
- To characterize the use and outcomes of in-hospital pediatric stroke alerts.
- To analyze the diagnoses associated with these alerts.
Main Methods:
- Retrospective review of a quality improvement database and medical records (April 2011–December 2016).
- Inclusion criteria: children (0–20 years) with new focal neurological defects within 48 hours, triggering an in-hospital stroke alert.
- Rapid neurologist evaluation (within 15 minutes) and magnetic resonance imaging (MRI) were available.
Main Results:
- 56 in-hospital stroke alerts were activated (median age 6.5 years).
- Stroke was diagnosed in 45% (25 children), predominantly ischemic (72%).
- Other urgent neurological conditions included seizure (21%) and posterior reversible encephalopathy syndrome (7%).
- Rapid neuroimaging was completed in 91% of cases.
Conclusions:
- 45% of in-hospital pediatric stroke alerts were for confirmed strokes; 38% were for other neurological conditions needing urgent assessment.
- Alerts were frequently used in children with complex medical histories.
- Rapid neurological evaluation improved care, but no patients received thrombolysis or thrombectomy.
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