Abstract 40: The Impact of an Institutional Acute Stroke Protocol on Time to Treatment of Childhood Stroke
Introduction: In pediatric stroke, reported median delays from symptom onset to imaging diagnosis are 16-24hrs. This results in delayed treatment initiation. The impact of an Acute Stroke Protocol in pediatric hospitals has not been reported. Such a program was implemented at SickKids in 2005. The current study measured the impact of this protocol on delays to diagnosis and initiation of antithrombotic agents.
Methods: We compared time to diagnosis and treatment in children (age 1mo-18yrs) with acute AIS diagnosed after stroke protocol implementation (‘post-protocol’ from 2005-2012), to 209 children diagnosed ‘pre-protocol’ 1992-2004. Focused health record reviews abstracted intervals from symptom onset to diagnosis and to initiation of first antithrombotic treatment. We statistically compared time intervals in pre and post-protocol cohorts.
Results: Among 118 children diagnosed post-protocol (75 outpatient and 43 inpatient strokes), median age was 5.8 years with 65 males. Median delay from symptom onset to diagnosis in post-protocol children was similar to pre-protocol children, for all strokes (19.9hrs vs 22.7hrs respectively; p=0.24), outpatient (22.4hrs vs 29.1hrs; p=0.12) and inpatient strokes (12.8hrs vs 14.6hrs; p=0.92). The main contributors to diagnosis beyond 6 hrs were delays in initial neuroimaging (25% of delays) and false-negative neuroimaging results (19% of delays) in CT scan as first test. The interval from diagnosis to antithrombotic treatment was more frequently within 24 hours for children treated post-protocol (55.1% vs 18.7% pre-protocol;p<0.0001) and in post-protocol children this interval was median 4.5 hrs (IQR 1.9-16.6). Also children with inpatient strokes more frequently received antithrombotic agents post-protocol (58% vs 35% pre-protocol;p=0.031). The types of antithrombotic treatments were similar (p=0.337).
Conclusions: The implementation of an Acute Stroke Protocol in our children’s hospital reduced the time to initiation of antithrombotic treatment. As thrombolysis and other hyper-acute treatments become available, the implementation of institutional Acute Stroke Protocols in children’s hospitals will be an important strategy to increase access to these therapies for children with AIS.
Author Disclosures: M. Shack: None. A. Andrade: None. M. Shroff: None. M. Moharir: None. I. Yau: None. R. Askalan: None. D. MacGregor: None. M.F. Rafay: None. J. Paterson: None. G.A. deVeber: None.
- © 2014 by American Heart Association, Inc.