A Review of Patient Population Requiring Novel Critical Care Pediatric Transport Stroke Clinical Practice Guideline: A Three Year Single Site Analysis

Abstract

<h3>Objectives</h3> 1. To identify patients transported by a pediatric critical care transport team for suspected or confirmed acute ischemic stroke who met qualifications of stroke activation. 2. Retrospective calculation of Large Vessel Occlusion (LVO) score of patients meeting criteria for transport stroke protocol activation. <h3>Background</h3> There are many pre-hospital Emergency Medical Service (EMS) and transport protocols as well as Large Vessel Occlusion (LVO) screening tools that exist for rapid transport of an adult patient with suspected or confirmed acute ischemic stroke to the nearest stroke center for rapid diagnosis. These screening algorithms aid in identifying adult patients who benefit from transport directly to an adult comprehensive stroke center. No data has been published on pre-hospital and transport evaluation and treatment algorithms for suspected acute ischemic stroke in children. Our institution created and implemented a transport stroke clinical practice guideline specific to pediatric stroke to improve recognition and management of patients with suspected stroke by our interfacility critical care transport team. <h3>Methods</h3> A retrospective chart review of patients transported by our institution's critical care transport teams from September 1, 2016 and March 1, 2020 meeting institutional criteria for stroke activation. LVO scores were calculated retrospectively based on clinical information documented within the transport medical record. <h3>Results</h3> Of the 17,244 patients transported by our institution's critical care transport, 17 patients met criteria during the defined study period. Average/median age was 173 months, or 14.4 years old. 4 of 17 had radiographic evidence of thrombus with 3 of those 4 underwent definitive management with tPA or endovascular retrieval. Hemiplegia is the most common presenting symptom with confirmed stroke in this population. The confirmed stroke group scored significantly lower on Glasgow Coma Scale (median of 8 vs. 15, p = 0.014), significantly higher on the LAMS LVO score (median 4 vs. 0, p = 0.021) and significantly higher on the RACE LVO (median 4 vs. 0, p = 0.036). <h3>Conclusion</h3> Acute ischemic stroke is a rare occurrence in pediatric patients. A standardized clinical practice guideline for transport can facilitate early recognition, appropriate management, and transport to a pediatric specific stroke care for timely diagnosis and intervention. LVO scores designed for adult population have not been validated for use in pediatric patients for suspected stroke, but may be useful in triage of pediatric patients with stroke-like symptoms to a stroke center with specialized care in pediatric stroke.