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Abstract

Introduction: The incidence of pediatric stroke is 0.63-2/100,000 person-yr and is associated with significant morbidity. The etiology of pediatric stroke differs from adults; however the management is similar due to the paucity of evidence in this population. The American Heart Association Target: Stroke Initiative facilitates rapid assessment in adults to expedite time-sensitive therapies such as recombinant tissue plasminogen activator. Hypothesis: A Pediatric Stroke Team (PST) will facilitate early recognition and standardize evaluation for pediatric stroke patients at our institution. Methods: A multidisciplinary team established evidence based guidelines for the management of pediatric stroke. The PST is staffed 24/7 by 3 physicians (pediatric neurology and critical care) and one nurse practitioner. Neuroradiology expedites diagnostic imaging for PST patients. Significant education was conducted prior to the PST implementation. Results: The PST was launched on Jan. 1, 2012 and has been consulted 36 times in the first 6 mo. Of those, 50% (18/36) identified stroke (12 acute ischemic stroke [AIS], 4 intracranial hemorrhage and 2 cerebral sinus venous thrombosis). In comparison, AIS was diagnosed in 5/10,000 hospital admissions from 2010-11. In the 2012 first half, AIS detection was 2 times that of prior. The majority of consults originated in the emergency department (ED) [11/18 (61%)] or an outside ED [4/18 (22%)]. Consults occurred on nights (5pm-7am) and weekends in 10/18 (56%) cases. Prompt evaluation (within 1h) by the PST enabled diagnostic imaging availability which was not previously available. Of patients with AIS, 6/12 (50%) obtained a brain magnetic resonance imaging (MRI) in a median 174 min [range 89-344 min]. Of the remaining, 4/12 (33%) were not clinically stable for MRI and 2/12 (17%) had an MRI performed prior to arrival at our facility. Conclusions: More aggressive surveillance has increased identification/diagnosis of pediatric stroke at our institution. Patient- level data are necessary to support the benefit of a PST and its ability to facilitate rapid assessment of patients for time sensitive therapies. Future study to evaluate the effects of a PST on patient outcomes is underway.