Abstract TP506: Decreasing the Time to Detection of Stroke After Cardiac Catheterization in Children

Abstract

Introduction: Children with congenital and acquired heart disease are at high risk for stroke. One-quarter of acute ischemic strokes (AIS) in children with cardiac disease occur in the peri-procedural period. Children with AIS can be treated successfully with hyperacute therapies. However, this requires timely identification of stroke, which has historically proved challenging in children. By developing and implementing a standardized screening assessment, we aim to decrease the time to detection of strokes occurring after cardiac catheterization in children. Methods: We retrospectively reviewed the medical records of children who had a stroke after cardiac catheterization at a tertiary children’s hospital between December 2006 and July 2016. We then developed a standardized screening stroke assessment. This was incorporated into the electronic medical record, and cardiology bedside nurses were trained in its use. The performance of the screen was analyzed retrospectively for children with a known stroke after cardiac catheterization. Results: Twenty children had a clinically-apparent stroke after cardiac catheterization prior to implementation of our screen. The time from the end of catheterization to the first documented assessment of neurologic function in any domain ranged from 22 minutes to 3.3 days (median 126 minutes). Given this variability, we developed a screening assessment that is brief, feasible, and within the scope of practice of cardiology bedside nurses. This was introduced to all nurses involved in the acute assessment of children after cardiac catheterization and is now performed on all children after catheterization. Retrospective application of the screen to the 20 children with a post-catheterization stroke would have resulted in detection of 18 (90%) of these strokes. Conclusion: Stroke after cardiac catheterization in children is rare; however, it is accompanied by a high rate of morbidity and mortality. The diagnosis of stroke after cardiac catheterization is often delayed. Development of screening methods to rapidly identify stroke in this population is feasible and has the potential to decrease the time to detection of stroke, thereby expanding access to hyperacute therapies.