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Published on: January 15, 2017
Performance of a Pediatric Stroke Alert Team Within a Comprehensive Stroke Center
Eva Catenaccio1, Becky J Riggs2, Lisa R Sun1,3
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Pediatric stroke teams can improve diagnosis, but delays in symptom recognition persist. Further interventions are needed to reduce the time to stroke alert activation in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Neurocritical Care
Background:
- Childhood stroke diagnosis is often delayed.
- Pediatric stroke teams can expedite evaluation and treatment.
- Timely diagnosis is crucial for acute pediatric neurologic emergencies.
Purpose of the Study:
- To analyze the utilization and timing of pediatric stroke team activations.
- To compare pediatric stroke team activations between inpatient and outpatient settings.
- To compare pediatric and adult stroke team activation parameters.
Main Methods:
- Retrospective analysis of pediatric stroke team (pedsBAT) activations from October 2014 to July 2017.
- Comparison of clinical characteristics and timing between inpatient and ED/outpatient pedsBAT activations.
- Comparison of pediatric and adult stroke team activation parameters.
Main Results:
- 120 pediatric stroke team activations were identified, with 75% in the ED/outpatient setting.
- Inpatient activations had higher rates of heart disease and altered mental status.
- Pediatric stroke team activation intervals were longer compared to adults, indicating delayed recognition.
Conclusions:
- Delays in symptom recognition contribute to longer activation intervals in pediatric stroke.
- Interventions are necessary to shorten the time to presentation and stroke alert activation in children.
- Optimizing pediatric stroke care pathways is essential for improving outcomes.
Background:
Childhood stroke is rare, and diagnosis is frequently delayed. The use of pediatric stroke teams has the potential to decrease time to neurology evaluation and imaging, hastening appropriate diagnosis and treatment for acute neurologic presentations in children.
Methods:
We performed a retrospective analysis of our institutional pediatric stroke or "brain attack" team (pedsBAT) activations from October 2014 to July 2017. Clinical characteristics and timing parameters were compared between pedsBAT activations in the inpatient vs emergency department (ED) / outpatient settings as well as between pediatric and adult BAT activations in the same time period.
Results:
We identified 120 pedsBAT activations (75% in the ED/outpatient setting) during the study time period. Inpatient pedsBAT activations were more likely than outpatient activations to have heart disease as a risk factor for ischemic stroke and presented more frequently with altered mental status, but there were no differences in the proportion of cerebrovascular diagnoses or timing parameters between the 2 groups. When compared with adult BAT activations, outpatient pedsBAT activations had a longer time from symptom discovery to arrival at the ED, and inpatient pedsBAT activations had longer time from symptom discovery to BAT activation.
Conclusions:
Compared with adults, the interval leading up to stroke team activation was longer in children, suggesting delays in symptom recognition. Future interventions should be aimed at reducing these delays in presentation to care and stroke alert activation in pediatric patients.
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