Abstract WP47: Creation of a Pediatric Stroke Alert Protocol

Abstract

Background: In 2021, our Comprehensive Stroke Center (CSC) in San Antonio (SA), Texas received 7 pediatric patients suffering from signs and symptoms of stroke. These patients ranged in age from 4-17 and approximately 57% were positive for an acute ischemic stroke (AIS). During the month of March, 2 patients were brought in via EMS and both MRIs were positive for AIS, prompting our stroke team to evaluate our adult processes. We concluded that an Emergency Department (ED) Pediatric Stroke Alert Protocol was needed in order for our hospital to have the capability to care for this patient population, and also appropriately triage and offer acute therapies to give these patients the best chance possible. Purpose: Develop an ED Pediatric Stroke Alert Protocol in order to provide rapid triage and advanced therapies if warranted. The ED Pediatric Stroke Alert protocol was developed with our same stroke alert time frame in mind, 0-6 hours, and with the age range of 2-17 years. Methods: An interdisciplinary team consisting of Vascular neurology, Pediatric Neurology, Pediatric Hematology/Oncology, Pediatric Critical Care nursing, Pediatric / Adult ED nursing & Faculty, Neuro Critical Care, Pharmacy, and our Stroke Team met to discuss how to implement a pediatric protocol. It was decided that modeling it after the Adult ED Stroke Alert Protocol would be best to limit confusion and triage errors. The Cincinnati Stroke Scale was used as the tool of choice in order for our ED team to identify stroke symptoms, also a time frame of less than 6 hours from onset of symptoms AND a blood glucose between 60 and 600. This would then prompt the activation of the Pedi ED Stroke Alert Protocol. Triage on the protocol includes inclusion and exclusion criteria for IV tPA, which was also tailored to the pediatric population with the help of Pediatric Hematology/Oncology. Results: The ED Pedi SA Protocol has since been revised to meet the needs of our changing pediatric stroke population. The CSC continues to treat pediatric patients and continues to develop other tools to meet the needs of this population. Conclusion: Our CSC has been categorized by EMS as one of the only CSCs in SA, Texas that is capable of providing complete stroke care to the pediatric population.