title: Prehospital Emergency Care in Childhood Arterial Ischemic Stroke.
abstract: Immediately calling an ambulance is the key factor in reducing time to hospital presentation for adult stroke. Little is known about prehospital care in childhood arterial ischemic stroke (AIS). We aimed to determine emergency medical services call-taker and paramedic diagnostic sensitivity and to describe timelines of care in childhood AIS.
  
  
  
  This is a retrospective study of ambulance-transported children aged <18 years with first radiologically confirmed AIS, from 2008 to 2015. Interhospital transfers of children with preexisting AIS diagnosis were excluded.
  
  
  
  Twenty-three children were identified; 4 with unavailable ambulance records were excluded. Nineteen children were included in the study. Median age was 8 years (interquartile range, 3-14); median Pediatric National Institutes of Stroke Severity Scale score was 8 (interquartile range, 3-16). Emergency medical services call-taker diagnosis was stroke in 4 children (21%). Priority code 1 (lights and sirens) ambulances were dispatched for 13 children (68%). Paramedic diagnosis was stroke in 5 children (26%), hospital prenotification occurred in 8 children (42%), and 13 children (68%) were transported to primary stroke centers. Median prehospital timelines were onset to emergency medical services contact 13 minutes, call to scene 12 minutes, time at scene 14 minutes, transport time 43 minutes, and total prehospital time 71 minutes (interquartile range, 60-85).
  
  
  
  Emergency medical services call-taker and paramedic diagnostic sensitivity and prenotification rates are low in childhood AIS.
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Belinda
authors.initials: B
authors.lastname: Stojanovski
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Paul T
authors.initials: PT
authors.lastname: Monagle
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Ian
authors.initials: I
authors.lastname: Mosley
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Leonid
authors.initials: L
authors.lastname: Churilov
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Fiona
authors.initials: F
authors.lastname: Newall
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.).
authors.forename: Grant
authors.initials: G
authors.lastname: Hocking
authors.affiliation: From the Neurology Department (B.S., M.T.M.) and Haematology Department (P.T.M., F.N.), Royal Children's Hospital, Victoria, Australia; Murdoch Childrens Research Institute, Victoria, Australia (B.S., P.T.M., F.N., M.T.M.); Florey Neurosciences Institute, Victoria, Australia (L.C., M.T.M.); Department of Paediatrics, University of Melbourne, Victoria, Australia (P.T.M., F.N., M.T.M.); La Trobe University, Victoria, Australia (I.M.); and Ambulance Victoria, Australia (G.H.). mark.mackay@rch.org.au.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Mackay
mesh_terms: D000293:Adolescent; D001315:Australia; D002545:Brain Ischemia / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*
keywords: caregiver; cerebrovascular disorder; child; emergency medical services; stroke