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
  ^∗
• Show all authors
• Show footnotes

Published:November 10, 2021DOI:https://doi.org/10.1016/j.jpeds.2021.10.048

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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.