Parental Care-Seeking Behavior and Prehospital Timelines of Care in Childhood Arterial Ischemic Stroke.
Taking appropriate action in the prehospital setting is important for rapid stroke diagnosis in adults. Data are lacking for children. We aimed to describe parental care-seeking behavior and prehospital timelines of care in childhood arterial ischemic stroke.



A structured questionnaire was developed, using value-focused event-driven conceptual modeling techniques, to interview parents of children presenting to the emergency department with arterial ischemic stroke from 2008 to 2014.



Twenty-five parents (median age 41 years, interquartile range 36-45) were interviewed. Twenty-four children were awake, and 1 child was asleep at stroke onset; 23 had sudden onset symptoms. Location at stroke onset included home (72%), school (8%), or other setting (20%). Carergivers present included parent (76%), another child (8%), teacher (4%), or alone (8%). Eighty-four percent of parents thought symptoms were serious, and 83% thought immediate action was required, but only 48% considered the possibility of stroke. Initial actions included calling an ambulance (36%), wait and see (24%), calling a general practitioner (16%) or family member (8%), and driving to the emergency department or family physician (both 8%). Median time from onset to emergency department arrival was 76 minutes (interquartile range 53-187), being shorter for ambulance-transported patients.



Stroke recognition and care-seeking behavior are suboptimal, with less than half the parents considering stroke or calling an ambulance. Initiatives are required to educate parents about appropriate actions to facilitate time-critical interventions.
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia. mark.mackay@rch.org.au.
Mark T
MT
Mackay
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
Belinda
B
Stojanovski
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
Ian
I
Mosley
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
Leonid
L
Churilov
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
Geoffrey A
GA
Donnan
From the Department of Neurology (M.T.M., B.S.) and Department of Haematology (P.M.) Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia (M.T.M., B.S., P.M.); Florey Institute of Neurosciences and Mental Health, Parkville, Australia (M.T.M., L.C., G.A.D.); Latrobe University, Melbourne, Australia (M.T.M., I.M.); and Department of Pediatrics (M.T.M., P.M.), and Department of Medicine (L.C., G.A.D.), University of Melbourne, Parkville, Australia.
Paul
P
Monagle
D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D004632:Emergency Medical Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D020521:Stroke / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors
cerebrovascular disease; childhood stroke; emergency medical; pediatric stroke; prehospital delay; stroke