Pediatric Acute Stroke Protocols in the United States and Canada

Authors

Dana B. Harrar, Department of Neurology, Children's National Hospital and Departments of Neurology and Pediatrics, George Washington University School of Medicine, Washington, DC.
Giulia M. Benedetti, Department of Neurology, Seattle Children's Hospital and University of Washington, Seattle, WA.
Anuj Jayakar, Department of Neurology, Nicklaus Children's Hospital, Miami, FL.
Jessica L. Carpenter, Department of Neurology, Children's National Hospital and Departments of Neurology and Pediatrics, George Washington University School of Medicine, Washington, DC.
Tara K. Mangum, Department of Neurology, Phoenix Children's Hospital, Phoenix, AZ.
Melissa Chung, Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Brian Appavu, Department of Neurology, Phoenix Children's Hospital, Phoenix, AZ.

Document Type

Journal Article

Publication Date

3-1-2022

Journal

The Journal of pediatrics

Volume

242

DOI

10.1016/j.jpeds.2021.10.048

Keywords

arterial ischemic stroke; endovascular thrombectomy; intravenous tissue plasminogen activator; mechanical thrombectomy; pediatric stroke; stroke alert

Abstract

OBJECTIVE: To describe existing pediatric acute stroke protocols to better understand how pediatric centers might implement such pathways within the context of institution-specific structures. STUDY DESIGN: We administered an Internet-based survey of pediatric stroke specialists. The survey included questions about hospital demographics, child neurology and pediatric stroke demographics, acute stroke response, imaging, and hyperacute treatment. RESULTS: Forty-seven surveys were analyzed. Most respondents practiced at a large, freestanding children's hospital with a moderate-sized neurology department and at least 1 neurologist with expertise in pediatric stroke. Although there was variability in how the hospitals deployed stroke protocols, particularly in regard to staffing, the majority of institutions had an acute stroke pathway, and almost all included activation of a stroke alert page. Most institutions preferred magnetic resonance imaging (MRI) over computed tomography (CT) and used abbreviated MRI protocols for acute stroke imaging. Most institutions also had either CT-based or magnetic resonance-based perfusion imaging available. At least 1 patient was treated with intravenous tissue plasminogen activator (IV-tPA) or mechanical thrombectomy at the majority of institutions during the year before our survey. CONCLUSIONS: An acute stroke protocol is utilized in at least 41 pediatric centers in the US and Canada. Most acute stroke response teams are multidisciplinary, prefer abbreviated MRI over CT for diagnosis, and have experience providing IV-tPA and mechanical thrombectomy. Further studies are needed to standardize practices of pediatric acute stroke diagnosis and hyperacute management.

APA Citation

Harrar, Dana B.; Benedetti, Giulia M.; Jayakar, Anuj; Carpenter, Jessica L.; Mangum, Tara K.; Chung, Melissa; and Appavu, Brian, "Pediatric Acute Stroke Protocols in the United States and Canada" (2022). GW Authored Works. Paper 682.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/682

Department

Pediatrics