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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Published on: January 15, 2017

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Use of a Stroke Alert Protocol and Outcomes at a Quaternary Children's Hospital

Benjamin Africk1, Ingrid Luo2, Andrew Silverman1

  • 1Division of Child Neurology, Department of Neurology, Stanford School of Medicine, Stanford, CA.

The Journal of Pediatrics
|October 20, 2024
PubMed

Insights

Implementing a pediatric stroke alert protocol improved diagnostic efficiency, significantly reducing code-to-image times for in-hospital pediatric stroke alerts. Out-of-hospital alerts did not show similar improvements.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Healthcare Quality Improvement

Background:

  • Pediatric stroke diagnosis requires rapid assessment and imaging.
  • Standardized alert protocols aim to improve diagnostic efficiency and patient outcomes.
  • In-hospital (IH) and out-of-hospital (OH) stroke alerts may have different activation and response characteristics.

Purpose of the Study:

  • To evaluate the impact of a pediatric stroke alert protocol on diagnostic efficiency.
  • To compare the characteristics of IH versus OH pediatric stroke alerts.
  • To assess changes in code-to-image (CTI) times after protocol implementation.

Main Methods:

  • Retrospective review of pediatric stroke alerts (October 2016-October 2022).
  • Analysis of code-to-image (CTI) times using generalized linear models.
  • Comparison of demographic, clinical, and imaging characteristics between IH and OH alerts.

Main Results:

  • Overall mean CTI time decreased by 4.56 minutes/year (P=.007).
  • IH alerts showed a significant decrease in CTI time (8.33 minutes/year), while OH alerts showed an increase (1.90 minutes/year).
  • CTI improved for CT/CTA and non-sedated MRI, but not for sedated MRI.

Conclusions:

  • A pediatric stroke alert protocol led to improved CTI times for in-hospital alerts.
  • Out-of-hospital pediatric stroke alerts did not demonstrate similar improvements in diagnostic efficiency.
  • Further optimization may be needed for out-of-hospital pediatric stroke alert pathways.
Abstract

Keywords:
hemorrhageischemiastrokethrombectomy

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