Pediatric stroke: do clinical factors predict delays in presentation?
OBJECTIVE
To explore associations between age, clinical presentation, or predisposing conditions and delayed diagnosis of arterial ischemic stroke.


METHODS
This was a retrospective chart review of children admitted to tertiary care medical centers in San Diego County between 1995 and 2000. Inpatient charts were screened by ICD-9 codes for stroke, cerebrovascular anomalies, hemiplegia, and migraine.


RESULTS
Time of presentation for medical evaluation did not differ by age group, clinical presentation, or risk factors. There was no relationship between time of presentation and Glasgow Outcome Score. Only 24% (9/37) of the patients with ischemic stroke presented for clinical evaluation within 6 hours after onset of symptoms, and an additional 41% (13/37) presented within the first 24 hours. Children who initially presented with altered mental status were more likely to die than those with other initial presentations (odds ratio = 9.94; 95% confidence interval = 2.05 to 47.9), but none of the 16 children who presented with hemiparesis died (P = .01).


CONCLUSIONS
Time of presentation was not related to the clinical factors studied. Early recognition of stroke in children is an important goal for families and health care providers.
Hartman
Adam L
AL
Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. ahartma2@jhmi.edu
Lunney
Kevin M
KM
Serena
Jacqueline E
JE
D000293:Adolescent; D001259:Ataxia / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications; D002140:California; D002543:Cerebral Hemorrhage / Q000150:complications; D002648:Child; D002675:Child, Preschool; D003221:Confusion / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010291:Paresis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality; D013997:Time Factors