Abstract TP501: The Pediatric Stroke Alert System: Evaluation of Time to Diagnosis and Treatment of Acute Childhood Stroke

Abstract

Introduction: With increasing interest in using thrombolytic and endovascular therapies in children, primary pediatric stroke centers are emerging to more quickly diagnose and treat childhood stroke. Successful centers must have an effective multidisciplinary stroke alert system aimed at early diagnosis and treatment of pediatric stroke. Objective and Hypothesis: Our objective is to evaluate the pediatric stroke alert system at the Johns Hopkins Children’s Center. We analyzed all 120 activations from October 2014 to July 2017 to assess the time to stroke evaluation, neuro-imaging, hyper-acute therapies, and diagnosis. Methods: The pediatric stroke alert system can be activated by any medical provider in any location at the Johns Hopkins Children’s Center including the transport team. Criteria for activation is acute onset of a focal neurological deficit within 12 hours of presentation. Once activated, a neurology resident evaluates the patient immediately and a neuroimaging is completed if indicated. Results: There were 120 pediatric stroke activations with 80 (67%) from the ED, 10 (8%) from outpatient locations (outside hospitals, EMS, clinics, transport teams), and 30 (25%) from the inpatient setting (PICU, OR, pediatric floors). For patients on inpatient units (floor, PICU, OR) the average time from symptom discovery to activation was 255 minutes (n=28, SD=387). For patients in the ED the average time from ED arrival to activation was 43 minutes (n=68, SD=82). A neurology resident was at the patient’s bedside within an average of 5.5 minutes of activation (n=103, SD=14). MRI imaging was obtained an average of 113 minutes (n=70, SD=246) after evaluation. Overall, 21 children (18%) were diagnosed with stroke, 16 (13%) migraines, 25 (21%) seizures, 5 (4%) with infections, 8 (7%) functional, and 45 (38%) were not given a neurologic diagnosis. Intravenous tPA was given to 1 patient and endovascular therapy was performed in 2 patients. Conclusions: The pediatric stroke alert system has transformed the initial management of acute stroke and other emergent neurologic presentations at the Johns Hopkins Children’s Center, streamlining their evaluation and offering the potential for time-limited reperfusion therapies.