We are now well past a simple awareness that strokes are not just for old folks. Yes, children have strokes, too, and the incidence may exceed 1 per 100 000 or even 10 000 annually (Emerg Med Int 2011;2011:734506), more common than many childhood cancers. But, can we detect these brain attacks sooner and save brain? In this volume of The Journal, Harrar et al deploy an historical cohort study in a single tertiary center to determine whether a stroke alert system decreased the time to diagnosis of children presenting to the emergency department with acute-onset focal neurologic deficits. After implementation of a stroke alert system, the median time from emergency department arrival until neuroimaging for children with acute-onset focal neurologic was 82 minutes, significantly less compared with the median 196 minutes before the alert system. Interestingly, as a secondary finding, this coordinated pediatric stroke protocol also led to more children being carefully evaluated for stroke. At the same time, the treating physicians were unable to distinguish who would or would not ultimately benefit from an intervention such at tissue plasminogen activator, although they did identify perceived potential candidates even more quickly than the median 82 minutes. The take-home message of this study is that we can and should do better identifying strokes in children. Such timely diagnosis is prerequisite to applying interventional therapies. Identification and treatment will also lead eventually to better primary and secondary prevention in those children at risk for stroke. It's time for us to save more children's brains. Article page 136▸ A Stroke Alert Protocol Decreases the Time to Diagnosis of Brain Attack Symptoms in a Pediatric Emergency DepartmentThe Journal of PediatricsVol. 216PreviewTo determine whether a stroke alert system decreases the time to diagnosis of children presenting to the emergency department (ED) with acute-onset focal neurologic deficits. Full-Text PDF
Read full abstract