Published Online
on December 1, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on May 18, 2005
Revised on August 16, 2005
Accepted on August 25, 2005

Urgent Clinical Challenges in Children With Ischemic Stroke/ Analysis of 1065 Patients From the 1-800-NOCLOTS Pediatric Stroke Telephone Consultation Service

Stefan Kuhle MD; Lesley Mitchell MSc; Maureen Andrew MD; Anthony K. Chan MBBS; Patricia Massicotte MD; Margaret Adams RN; and Gabrielle deVeber MD

From the Department of Pediatrics (S.K., L.M., P.M.), Thrombosis Program, Stollery Children’s Hospital, Edmonton, Alberta, Canada; Department of Pediatrics (M. Andrew, deceased), Division of Hematology, Hospital for Sick Children, Toronto Ontario, Canada; Department of Pediatrics (A.K.C.), Division of Hematology, Children’s Hospital at Chedoke McMaster, Hamilton, Ontario, Canada; and Department of Pediatrics (M. Adams, G.d.), Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada.

Background and Purpose--Clinical trials are lacking in pediatric stroke. As a result, physicians caring for children with stroke face significant challenges. The patient characteristics and specific nature of clinical challenges facing practicing clinicians can inform the design of and priorities for developing relevant clinical trials.

Methods--Physicians consulted the 1-800-NOCLOTS toll-free pediatric stroke telephone consultation service on children (birth to 18 years) with ischemic stroke. Pediatric neurologist or hematologists provided telephone consultation and documented caller and patient characteristics, antithrombotic treatments and callers’ questions for entry into a computerized database. Children referred from January 1, 1995 to January 1, 2004, comprised the study cohort.

Results--Stroke consults were completed on 1065 children located predominantly in the United States (76%). Children had arterial ischemic stroke (AIS; 679; 64%) or cerebral sinovenous thrombosis (CSVT; 386; 36%) and were 54% male and 16% neonates. Risk factors and antithrombotic agents (none, aspirin, warfarin, and heparins) differed by stroke type. In 60% of patients, callers had not initiated antithrombotic therapy. Callers’ questions for both stroke types usually concerned treatment selection (83%), but for AIS, questions more frequently (P<0.0001) concerned the selection and interpretation of etiological investigations.

Conclusions--Research is urgently needed in pediatric stroke to provide direction for management in "real-life" settings. Research efforts should address the unique challenges within different stroke types and include observational studies addressing investigation of the child with AIS. For AIS and CSVT, randomized controlled trials investigating the efficacy of antithrombotic treatment are urgently needed.

Key words: infants • child • sinus thrombosis • stroke, ischemic

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