title: Pediatric Stroke Clinical Pathway Improves the Time to Diagnosis in an Emergency Department.
abstract: Identified barriers to the diagnosis of pediatric stroke include delays in provider recognition and definitive neuroimaging (magnetic resonance imaging). Clinical pathways are recommended to address these barriers; yet few studies have evaluated their impact. Our aim is to describe the effect of a pediatric stroke clinical pathway on the diagnosis of stroke in patients presenting with focal neurological dysfunction to a pediatric emergency department.
  
  
  
  The pediatric stroke clinical pathway was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. Demographic and clinical data were collected for patients ultimately diagnosed with stroke using the pediatric stroke clinical pathway and compared with data collected on patients diagnosed with stroke before implementation of the pediatric stroke clinical pathway.
  
  
  
  The pediatric stroke clinical pathway was activated for 36 patients. Stroke was diagnosed in 11 patients (33%), of whom 55% were male with a median age 11 ± 7 years. Focal deficits (82%) and headache (55%) were common presenting complaints. There was a significant improvement in the median time to magnetic resonance imaging from arrival to the emergency department (before implementation of the pediatric stroke clinical pathway: 17 hours [interquartile range 6, 22] versus after implementation of the pediatric stroke clinical pathway: four hours [interquartile range 3, 12]; P = 0.02).
  
  
  
  The pediatric stroke clinical pathway improved time to definitive diagnosis and streamlined the care provided to children presenting to the pediatric emergency department with focal neurological dysfunction.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan. Electronic address: adelaroc@dmc.org.
authors.forename: Amy M
authors.initials: AM
authors.lastname: DeLaroche
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Lalitha
authors.initials: L
authors.lastname: Sivaswamy
authors.affiliation: Department of Pediatrics, Children's Research Center of Michigan, School of Medicine, Wayne State University, Detroit, Michigan.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Farooqi
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Kannikeswaran
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019091:Critical Pathways / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008279:Magnetic Resonance Imaging / Q000592:standards; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D061665:Time-to-Treatment / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000592:standards
keywords: cerebral infarction; clinical pathway; diagnosis; magnetic resonance imaging; pediatric stroke