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Study shows effectiveness of pediatric stroke protocol

Jul. 23, 2015, 9:18 AM

A system to ensure that children with stroke-like symptoms receive emergency evaluations results in faster diagnosis and treatment for patients with the condition, a team of physicians and researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt has shown.

The team reviewed patient data from the more than four years since Children’s Hospital implemented a stroke alert rapid response protocol in 2011. They found that the system was effective at diagnosing strokes quickly, improving the chances that brain-saving interventions could be used.

(Monroe Carell Jr. Children’s Hospital at Vanderbilt)

Their findings were published recently in the American Heart Association’s journal Stroke.

“Just as there are rapid response protocols for adults with a possible stroke, there should be a rapid response protocol for children with a possible stroke or rapid transfer to a medical center with pediatric stroke expertise,” said Lori Jordan, M.D., Ph.D., assistant professor of Pediatrics and Neurology and director of the Vanderbilt Pediatric Stroke Program.

“We need the Emergency Department, Radiology, Critical Care Medicine and often many other specialists to work quickly and efficiently together to treat pediatric patients.”

Under the protocol, Emergency Department patients with stroke-like symptoms are seen by a Neurology resident within 15 minutes and an emergency MRI is considered.

“These data show that our emergency providers are very good at identifying children who might have a stroke or other serious illness,” Jordan said. “Neurologists see these children rapidly, and radiologists help us image and diagnose them quickly. This is a wonderful example of teamwork at Vanderbilt.”

Of the 124 children who were seen during the period reviewed, 24 percent had suffered a stroke, and altogether 40 percent were seriously ill with either a stroke, transient ischemic attack or other neurological emergencies.

Because strokes are more commonly associated with adult patients, signs and symptoms of pediatric stroke often go unnoticed or are discovered too late, Jordan said.

“Rapid evaluation and appropriate testing is critical,” Jordan said. “Prior studies have suggested that stroke in children often takes a long time to diagnose due to delays in imaging. In one recent Canadian study, in-hospital delay was 12.7 hours for children with stroke.”

At Vanderbilt, the average time to initiate an MRI was 94 minutes.

The study suggests that all hospitals should have systems in place to quickly diagnose pediatric strokes and treat or urgently transfer these patients, Jordan said.

“Know the symptoms of stroke and consider the possibility of a stroke no matter what a person’s age, and have your child rapidly evaluated,” Jordan said. “We think children should have this same standard of care.”

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