title: Are children with acute arterial ischaemic stroke eligible for hyperacute thrombolysis? A retrospective audit from a tertiary UK centre.
abstract: OBJECTIVE
  The aim of this study was to evaluate the number of children with acute arterial ischaemic stroke (AIS) who would have been eligible for hyperacute thrombolysis in the authors' unit (Great Ormond Street Hospital, London, UK) and to identify barriers to this treatment.
  
  
  METHODS
  We compared the characteristics of children with a diagnosis of acute AIS, identified from neuroimaging databases, seen at our centre between January 2006 and December 2011. The criteria for hyperacute thrombolysis were predefined by us: age ≥8y; imaging-confirmed diagnosis of acute AIS and arrival at our centre within 6 hours of symptom onset; occluded major artery on computed tomography (CT) or magnetic resonance angiography; no contraindications. Factors that precluded therapy were examined.
  
  
  RESULTS
  Of a total of 107 children with acute AIS identified on MRI (n=64; 33 females, 31 males; median age 4y, range 1mo-17y) or CT databases (n=43; 14 females, 29 males; median age 1y, range 1mo-15y), none would have been eligible for hyperacute thrombolysis. The major barriers to this were (1) delayed diagnosis, (2) delayed transfer to the tertiary centre, (3) age, and (4) medical comorbidities. Of 107 children, three (2.8%) would have been eligible for thrombolysis if diagnosis and transfer had occurred in a timely manner. An additional 11 children (10.3%) would have been eligible if the age criterion was 28 days or more and if diagnosis and transfer had occurred promptly.
  
  
  CONCLUSIONS
  Although hyperacute thrombolysis is, as yet, an unproven treatment in childhood AIS, at least a subset of patients could potentially benefit. This audit has identified that clinical factors preclude treatment in a high percentage of children. Furthermore, in our specialist unit, without an emergency department, we identified major logistic barriers that will need to be addressed to enable access to hyperacute therapies. These results could inform future trial design and service delivery.
authors.affiliation: Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Clara
authors.initials: C
authors.lastname: Marecos
authors.forename: Roxana
authors.initials: R
authors.lastname: Gunny
authors.forename: Robert
authors.initials: R
authors.lastname: Robinson
authors.forename: Vijeya
authors.initials: V
authors.lastname: Ganesan
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D016208:Databases, Factual; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010360:Patient Transfer; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D062606:Tertiary Care Centers; D015912:Thrombolytic Therapy / Q000379:methods*; D006113:United Kingdom