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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Determinants of Timely Access to Recanalization Treatments and Outcomes in Pediatric Ischemic Stroke
Raluca Tudorache1,2,3,4, Manoëlle Kossorotoff3,5,6, Basile Kerleroux6,7,8
1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (R.T.).
Insights
Prehospital triage significantly reduces treatment delays for pediatric acute arterial ischemic stroke (AIS). This approach improves outcomes, highlighting the need for specialized pediatric stroke protocols.
Area of Science:
- Neurology
- Pediatric Stroke
- Emergency Medicine
Background:
- Timely revascularization is critical for acute arterial ischemic stroke (AIS) outcomes.
- Factors contributing to treatment delays in pediatric AIS are not well understood.
- This study investigates determinants of treatment delay in pediatric AIS.
Purpose of the Study:
- To identify factors influencing treatment delays in pediatric AIS.
- To assess the impact of prehospital triage on treatment times and outcomes.
- To evaluate the role of admission type and unit specialization in pediatric AIS treatment.
Main Methods:
- Ancillary analysis of the French KID-CLOT study (2015-2018).
- Inclusion of pediatric AIS patients receiving IV thrombolysis or mechanical thrombectomy.
- Assessment of prehospital triage, admission type, and unit type on delay and outcomes (modified Rankin Scale at 1 year).
Main Results:
- Prehospital triage significantly reduced delay from last-known-well to treatment (229 vs. 270 minutes, P=0.01).
- Mechanical thrombectomy showed the most significant delay reduction with prehospital triage (P<0.001).
- Prehospital triage correlated with improved outcomes (lower modified Rankin Scale scores, P=0.021).
Conclusions:
- Prehospital triage is crucial for reducing treatment delays in pediatric AIS.
- Implementing a dedicated prehospital stroke protocol for children is recommended.
- Optimized prehospital care can improve clinical outcomes for pediatric AIS patients.
Background:
Timely revascularization in acute arterial ischemic stroke (AIS) is paramount for optimal outcomes. However, factors causing treatment delays in pediatric AIS remain understudied. We investigated determinants affecting the time from symptom onset or last-known-well to the start of recanalization treatment in pediatric AIS.
Methods:
We conducted an ancillary analysis of the French KID-CLOT study (The National Retrospective Study of Recanalization Treatments in Pediatric Arterial Ischemic Stroke), considering patients with pediatric AIS receiving recanalization treatments (IV thrombolysis IVT and mechanical thrombectomy) from 2015 to 2018. The study assessed prehospital triage's impact, direct versus transferred admissions, and unit type (pediatric versus adult) on treatment delay and clinical outcomes using modified Rankin Scale at 1 year.
Results:
Among 68 patients (median age, 11 [IQR, 4-16]; initial PedNIHSS, 13 [IQR, 7-19]), treatment modalities were IVT (n=31), and mechanical thrombectomy (n=23), and IVT+mechanical thrombectomy (n=14). Prehospital triage significantly reduced last-known-well to treatment delay (overall, 229 versus 270 minutes; P=0.01), most notably for and mechanical thrombectomy (P<0.001). There was no substantial delay difference between direct and transferred admissions, or between unit types, although a trend favored adult units (370.3 versus 436.73 minutes; P=0.06). Prehospital triage correlated with improved outcomes, with a shift to lower modified Rankin Scale scores (P=0.021).
Conclusions:
For pediatric AIS treated with reperfusion therapy, prehospital triage emerges as a pivotal factor in reducing treatment delays and enhancing outcomes. These findings underscore the need for a dedicated prehospital stroke protocol for children.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03887143.
