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Improving Timely Diagnosis of Arterial Ischemic Stroke at a Pediatric Emergency Department
Theodore E Trigylidas1,2, Nichole L McCollum1,2, Kathleen M Brown1,2
1Children's National Hospital, Washington, DC.
Insights
Implementing a stroke alert team significantly reduced diagnosis time for pediatric arterial ischemic stroke (AIS). This protocol improvement ensures faster neuroimaging for children with suspected AIS, improving critical care.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Quality Improvement Science
Background:
- Pediatric arterial ischemic stroke (AIS) is a critical condition demanding rapid diagnosis for effective hyperacute treatment.
- Timely recognition of AIS in children is essential to mitigate significant morbidity and mortality.
Purpose of the Study:
- To enhance the prompt diagnosis of pediatric AIS by implementing an interdisciplinary stroke response protocol.
- To reduce the median door-to-imaging time for pediatric patients presenting with suspected AIS.
Main Methods:
- A quality improvement initiative utilizing Plan-Do-Study-Act cycles was conducted from November 2019 to June 2023.
- Interventions included educational programs, a dedicated stroke alert paging system, and optimized stroke order sets.
- Data from 71 pediatric patients (0-21 years) with suspected AIS undergoing emergency department neuroimaging were analyzed.
Main Results:
- Median door-to-imaging time for suspected AIS decreased from 128 minutes to 68 minutes post-intervention.
- For patients with confirmed AIS on neuroimaging, median door-to-imaging time also improved to 68 minutes.
- Statistical process control charts monitored changes in door-to-imaging times over the study period.
Conclusions:
- The establishment of stroke alert teams can significantly improve the coordination of care for pediatric AIS.
- Expedited neuroimaging for children with suspected AIS is achievable through structured stroke response protocols.
- Interdisciplinary collaboration is key to enhancing the efficiency of diagnosing pediatric stroke.
Background And Objectives:
Pediatric arterial ischemic stroke (AIS) is an important cause of morbidity and mortality that requires early recognition to benefit from hyperacute therapies. We sought to improve timely diagnosis of AIS through an interdisciplinary stroke response protocol.
Methods:
A quality improvement initiative was implemented at our pediatric hospital emergency department from November 2019 to June 2023. We introduced a series of Plan-Do-Study-Act cycles that included educational initiatives (October 2021), the development of a stroke alert paging system to key stakeholders (November 2021), and stroke order set modifications (April 2022). All patients aged 0 to 21 years with clinical concern for AIS that had neuroimaging performed in the emergency department met criteria for inclusion in analysis. Our outcome measure was improvement of median door-to-imaging time for children with suspected AIS. Median door-to-imaging times for patients with confirmed stroke on imaging were also measured. Statistical process control charts were used to monitor data over time.
Results:
A total of 71 patients met criteria for inclusion in analysis during our study period. Four patients had confirmed AIS on neuroimaging. Median door-to-imaging time improved from 128 minutes to 68 minutes after intervention. Times improved from 113 minutes to 68 minutes for patients with confirmed stroke.
Conclusion:
Stroke alert teams may be beneficial for coordination of care and support in ensuring a higher proportion of children with clinical concern for AIS receive expedited neuroimaging.
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