Abstract NS3: Are You Ready For Your Pediatric Stroke Patient?

Abstract

Background: Our Comprehensive Stroke Center (CSC) located in Atlanta, had a pediatric patient present with stroke symptoms to our ED. We did not have a plan except to transfer to the closest Children’s Hospital approximately 15 miles away which In Atlanta, can be a 45-minute travel time. Our seasoned CSC treats over 2000 adult stroke patients annually however was not prepared for our pediatric patient population. After the patient was successfully enroute to Children's Hospital, a team quickly assembled to debrief and discuss a plan to treat. Since our hospital does not have a Pediatric Intensive Care, a "Drip and Ship" model would be the focus of care. Our hospital is a level 2 trauma center therefore keeping within the age range of >14 through the 18th birthday. Purpose: Develop a "Drip and Ship" model for pediatric stroke patients using best practice for stroke treatment inside ages 14- <18 years of age. This model utilizes our available Pediatric Emergency and Neurology teams while keeping the patient and family at the center of our care. Methods: Phase I included a interdisciplinary planning committee to review current literature, treatment parameters, medications, and dosing for the pediatric population related to acute stroke treatment. Risk assessment to ensure patient safety was a top priority for each step of the process. Clinical Practice Guidelines supports the rationale behind treating the pediatric stroke patient and transport to the Children’s Hospital. Phase II will include Neuro Endovascular evaluation for potential treatment with thrombectomy and subsequent admission to our Neuro ICU. Results: A “Drip and Ship” protocol was developed using evidence-based literature to guide emergent brain imaging, immediate consultation with Pediatric Neurologist and dosing guidelines for IV Alteplase. The team identified parameters and treatment for hypertension, angioedema and hemorrhagic conversion included in the newly developed pediatric stroke order set and Alaris pump build. Finally, a family centered brochure explaining the treatment for stroke along with directions to the Children’s Hospital completed this phase.