Improving Timely Diagnosis of Arterial Ischemic Stroke at a Pediatric Emergency Department

 Are you 100% positive your competent? hospital can correctly identify and treat young adult strokes?

You don't want to have a young adult stroke because:

1. Misdiagnosis

   Rather than relying on your doctor to diagnose young adult strokes, it is much better for you to instruct your children to have all the classic signs.

   It is your responsibility to have ALL the classic symptoms:

   Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes. Sudden trouble walking, dizziness, loss of balance, or lack of coordination.

   Don't do the dizziness one, if you're a young adult you'll get nailed for intoxication of some sort.
   

    

   Amy on her 36 hour wait for a diagnosis.

   
   

   ‘Doesn’t Look Like He Needs an Ambulance’: 17-Year-Old Boston Student Has Stroke In Class. School Nurse Argues with His Mom to Pick Him Up Instead of Calling 911

    The latest here:

Improving Timely Diagnosis of Arterial Ischemic Stroke at a Pediatric Emergency Department

Theodore E. Trigylidas, MD;

Nichole L. McCollum, MD;

Kathleen M. Brown, MD;

Joshua C. Heffren, PharmD, BCPPS;

Elizabeth M. Wells, MD;

Paola Pergami, MD, MHSc;

Jonathan Murnick, MD;

Deborah LaViolette, BSN;

Dana B. Harrar, MD, PhD

Address correspondence to: Theodore E. Trigylidas, MD, Children’s National Hospital Division of Emergency Medicine, 111 Michigan Ave NW, Washington, DC 20010. ttrigylida@childrensnational.org

Pediatrics e2024067166.

https://doi.org/10.1542/peds.2024-067166

Article history

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BACKGROUND AND OBJECTIVES

Pediatric arterial ischemic stroke (AIS) is an important cause of morbidity and mortality that requires early recognition to benefit from hyperacute therapies. We sought to improve timely diagnosis of AIS through an interdisciplinary stroke response protocol.

METHODS

A quality improvement initiative was implemented at our pediatric hospital emergency department from November 2019 to June 2023. We introduced a series of Plan-Do-Study-Act cycles that included educational initiatives (October 2021), the development of a stroke alert paging system to key stakeholders (November 2021), and stroke order set modifications (April 2022). All patients aged 0 to 21 years with clinical concern for AIS that had neuroimaging performed in the emergency department met criteria for inclusion in analysis. Our outcome measure was improvement of median door-to-imaging time for children with suspected AIS. Median door-to-imaging times for patients with confirmed stroke on imaging were also measured. Statistical process control charts were used to monitor data over time.

RESULTS

A total of 71 patients met criteria for inclusion in analysis during our study period. Four patients had confirmed AIS on neuroimaging. Median door-to-imaging time improved from 128 minutes to 68 minutes after intervention. Times improved from 113 minutes to 68 minutes for patients with confirmed stroke.

CONCLUSION

Stroke alert teams may be beneficial for coordination of care and support in ensuring a higher proportion of children with clinical concern for AIS receive expedited neuroimaging.

Subjects:

Emergency Medicine, Neurologic Disorders, Quality Improvement

Topics:

cerebrovascular accident, ischemic stroke, mineralocorticoid receptor antagonists, computed tomographic angiography

Copyright © 2025 by the American Academy of Pediatrics