Getting Organized for the Kids

Rapid response to children’s stroke symptoms may speed diagnosis

An emergency room rapid response plan for children can help diagnose stroke symptoms quickly, a new study has found.

Some children’s hospitals already have rapid response processes for when a child comes in with stroke-like symptoms, but most hospitals do not, said Lori Jordan, M.D., Ph.D., the study’s senior author. A rapid response plan should include expedited evaluation and imaging or swift transfer to a medical center with pediatric stroke expertise, she said.

"We need the emergency department, radiology, critical care medicine and often many other specialists to work quickly and efficiently together to treat pediatric patients," said Jordan, an assistant professor of pediatrics and neurology at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville.

The study, published in the American Heart Association’s journal Stroke, involved a review of data from Vanderbilt’s pediatric stroke program. Researchers established a "stroke alert" plan in the emergency room that requires a neurology resident to see a child with stroke symptoms within 15 minutes and for most children, quickly obtain an MRI.

During a three-year period, 124 children came in with stroke-like symptoms. One in four had experienced a stroke, while 2 percent had a TIA. The most common symptoms were weakness, altered mental status and headache.

Dr. Lori Jordan

Although uncommon, pediatric stroke is among the top 10 causes of death in children and more than half of survivors are significantly disabled, Jordan said.

In the new study, it took a median 28 minutes from emergency department arrival to neurology consultation, and seven minutes from consultation to neurologist at bedside. Most children received an MRI, which was done about an hour and a half after arrival. For children who had a CT scan, an hour elapsed between arrival and the scan.

"Rapid evaluation and appropriate testing is critical," said Jordan, who also is director of the Vanderbilt Pediatric Stroke Program. "Prior studies have suggested that stroke in children often takes a long time to diagnose due to delays in imaging."

One recent Canadian study found imaging was delayed nearly 13 hours for children with strokes.

A push by doctors to expand the use of rapid response plans for children began about a decade ago, Jordan said. "But more work is needed," she 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.

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AHA-ASA Resources

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