Related Experiment Video
Updated: Dec 26, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Pediatric Acute Stroke Protocol Implementation and Utilization Over 7 Years
Jessica D Wharton1, Megan M Barry2, Chelsea A Lee1
1Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Insights
This study shows that a pediatric acute stroke protocol improved over time, with increased use of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) and MRI. However, the frequency of confirmed strokes remained stable, highlighting the protocol
Area of Science:
- Pediatric neurology
- Emergency medicine
- Quality improvement science
Background:
- Pediatric acute stroke protocols are crucial for timely diagnosis and management.
- Evaluating the long-term implementation and utilization of such protocols is essential for optimizing care.
Purpose of the Study:
- To examine the implementation and utilization of a pediatric acute stroke protocol over a 7-year period.
- To hypothesize improvements in protocol implementation and increased protocol use over time.
Main Methods:
- Retrospective observational study of clinical and demographic data from 2011-2018.
- Comparison of the initial 43 months of protocol use (period 1) with the subsequent 43 months (period 2).
- Analysis of protocol activations, final diagnoses, neurological assessments (Pediatric National Institutes of Health Stroke Scale - PedNIHSS), and neuroimaging (MRI).
Main Results:
- Protocol activation increased by 56% from period 1 to period 2.
- Pediatric National Institutes of Health Stroke Scale documentation significantly increased from 42% to 82% (P < .001).
- Use of MRI as the first neuroimaging study increased from 68% to 78% (P = .038), while stroke diagnosis frequency remained stable.
Conclusions:
- Pediatric stroke protocol implementation improved, evidenced by increased PedNIHSS documentation and MRI utilization.
- Despite increased protocol use, the frequency of confirmed strokes and other neurologic emergencies remained stable.
- The consistent need for the protocol underscores its importance in managing pediatric stroke and emergencies.
Objective:
To examine the implementation and utilization of a pediatric acute stroke protocol over a 7-year period, hypothesizing improvements in protocol implementation and increased protocol use over time.
Study Design:
Clinical and demographic data for this retrospective observational study from 2011 through 2018 were obtained from a quality improvement database and medical records of children for whom the acute stroke protocol was activated. The initial 43 months of the protocol (period 1) were compared with the subsequent 43 months (period 2).
Results:
Over the 7-year period, a total of 385 stroke alerts were activated, in 150 children (39%) in period 1 and 235 (61%) in period 2, representing a 56% increase in protocol activation. Stroke was the final diagnosis in 80 children overall (21%), including 38 (25%) in period 1 and 42 (19%) in period 2 (P = .078). The combined frequency of diagnosed stroke, transient ischemic attack (TIA), and other neurologic emergencies remained stable across the 2 time periods at 39% and 37%, respectively (P = .745). Pediatric National Institutes of Health Stroke Scale (PedNIHSS) documentation increased from 42% in period 1 to 82% in period 2 (P < .001). Magnetic resonance imaging (MRI) was the first neuroimaging study for 68% of the children in period 1 vs 78% in period 2 (P = .038). All children with acute stroke received immediate supportive care.
Conclusions:
Pediatric stroke protocol implementation improved over time with increased use of the PedNIHSS and use of MRI as the first imaging study. However, with increased utilization, the frequency of confirmed strokes and other neurologic emergencies remained stable. The frequency of stroke and other neurologic emergencies in these children affirms the importance of implementing and maintaining a pediatric acute stroke protocol.
