Article

We aimed to evaluate whether an institutional acute stroke protocol (ASP)
could accelerate the diagnosis and secondary treatment of pediatric stroke.
METHOD: We initiated an ASP in 2005. We compared 209 children (125 males, 84
females; median age 4.8y, interquartile range [IQR] 1.2-9.3y, range 0.09-17.7y)
diagnosed with arterial ischemic stroke 'pre-protocol' (1992-2004) to 112
children (60 males, 52 females; median age 5.8y, IQR 1.0-11.4y, range 0.08-17.7y)
diagnosed 'post-protocol' (2005-2012) for time-to-diagnosis, mode of diagnostic
imaging, and time-to-treatment with antithrombotic medication (aspirin or
anticoagulants). RESULTS: Overall, the interval from symptom onset to diagnosis
was similar post-protocol compared to pre-protocol (20.3 vs 22.7h; p=0.109),
although mild strokes (Pediatric National Institute of Health Stroke Scale
[PedNIHSS] 0-4), were diagnosed faster post-protocol (12.1 vs 36.3h; p=0.003).
Magnetic resonance imaging (MRI) was the initial diagnostic modality more often
post-protocol (25% vs 1.4%; p<0.001). Initial MRI was more accurate for
diagnosing stroke than initial CT (100% vs 47%; p<0.001) with similar
time-to-diagnosis. The proportion of children receiving antithrombotic medication
within 24 hours doubled in the post-protocol period (83% vs 36%; p<0.001).
INTERPRETATION: A pediatric ASP accelerated time-to-treatment, time-to-diagnosis
in children with subtle strokes, and increased MRI as initial imaging, reducing
the need for computed tomography. Implementing optimized ASPs can facilitate more
timely access to diagnosis and management of children with acute stroke.
CI - (c) 2016 Mac Keith Press.

Langue : ANGLAIS