title: Urgent clinical challenges in children with ischemic stroke: analysis of 1065 patients from the 1-800-NOCLOTS pediatric stroke telephone consultation service.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatrics, Thrombosis Program, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kuhle
authors.forename: Lesley
authors.initials: L
authors.lastname: Mitchell
authors.forename: Maureen
authors.initials: M
authors.lastname: Andrew
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Chan
authors.forename: Patricia
authors.initials: P
authors.lastname: Massicotte
authors.forename: Margaret
authors.initials: M
authors.lastname: Adams
authors.forename: Gabrielle
authors.initials: G
authors.lastname: deVeber
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006405:Hematology / Q000379:methods; D006801:Humans; D007511:Ischemia / Q000473:pathology; D008297:Male; D009422:Nervous System Diseases / Q000473:pathology; D009462:Neurology / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D014652:Vascular Diseases / Q000473:pathology; D020246:Venous Thrombosis / Q000473:pathology
chemical_list: D005343:Fibrinolytic Agents