Deans' stroke musings: Pediatric Acute Stroke Protocols in the United States and Canada

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, November 15, 2021

Pediatric Acute Stroke Protocols in the United States and Canada

With no publication of what those protocols are we can't compare our hospital to what should be done during a pediatric stroke. And can't tell how bad our hospital is.

Pediatric Acute Stroke Protocols in the United States and Canada

Dana B. Harrar, MD PhD
Giulia M. Benedetti, MD
Anuj Jayakar, MD
Brian Appavu, MD
on behalf of theInternational Pediatric Stroke Study Group
^∗
Pediatric Neurocritical Care Research Group
^∗
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Published:November 10, 2021DOI:https://doi.org/10.1016/j.jpeds.2021.10.048

Objective

To describe existing pediatric acute stroke protocols to understand better how pediatric centers might implement such pathways within the context of institution-specific structures.

Study design

We performed an internet-based survey of pediatric stroke specialists. The survey queried hospital demographics; child neurology and pediatric stroke demographics; acute stroke response; imaging; and hyperacute treatment.

Results

47 surveys were analyzed. Most respondents practice at large, freestanding children’s hospitals with moderate-sized neurology departments and at least one neurologist with expertise in pediatric stroke. Although there is variability in how hospitals deploy stroke protocols, particularly in regard to staffing, the majority of institutions have an acute stroke pathway and almost all include activation of a stroke alert page. Most institutions prefer magnetic resonance imaging (MRI) over computed tomography (CT) and employ abbreviated MRI protocols for acute stroke imaging. Most institutions also have either CT- or MR-based perfusion imaging available. At least one patient was treated with intravenous tissue plasminogen activator (IV-tPA) or mechanical thrombectomy (MT) at the majority of institutions during the year prior to our survey.

Conclusions

An acute stroke protocol is utilized in at least 41 pediatric centers in the United States and Canada. Most acute stroke response teams are multidisciplinary, prefer abbreviated MRI over CT for diagnosis, and have experience providing IV-tPA and MT. Further studies are needed to standardize practices of pediatric acute stroke diagnosis and hyperacute management.