title: A pediatric institutional acute stroke protocol improves timely access to stroke treatment.
abstract: We aimed to evaluate whether an institutional acute stroke protocol (ASP) could accelerate the diagnosis and secondary treatment of pediatric stroke.
  
  
  
  We initiated an ASP in 2005. We compared 209 children (125 males, 84 females; median age 4.8y, interquartile range [IQR] 1.2-9.3y, range 0.09-17.7y) diagnosed with arterial ischemic stroke 'pre-protocol' (1992-2004) to 112 children (60 males, 52 females; median age 5.8y, IQR 1.0-11.4y, range 0.08-17.7y) diagnosed 'post-protocol' (2005-2012) for time-to-diagnosis, mode of diagnostic imaging, and time-to-treatment with antithrombotic medication (aspirin or anticoagulants).
  
  
  
  Overall, the interval from symptom onset to diagnosis was similar post-protocol compared to pre-protocol (20.3 vs 22.7h; p=0.109), although mild strokes (Pediatric National Institute of Health Stroke Scale [PedNIHSS] 0-4), were diagnosed faster post-protocol (12.1 vs 36.3h; p=0.003). Magnetic resonance imaging (MRI) was the initial diagnostic modality more often post-protocol (25% vs 1.4%; p<0.001). Initial MRI was more accurate for diagnosing stroke than initial CT (100% vs 47%; p<0.001) with similar time-to-diagnosis. The proportion of children receiving antithrombotic medication within 24 hours doubled in the post-protocol period (83% vs 36%; p<0.001).
  
  
  
  A pediatric ASP accelerated time-to-treatment, time-to-diagnosis in children with subtle strokes, and increased MRI as initial imaging, reducing the need for computed tomography. Implementing optimized ASPs can facilitate more timely access to diagnosis and management of children with acute stroke.
authors.affiliation: Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Shack
authors.affiliation: Neurology Section, Department of Paediatrics, University of Western Ontario, London, ON, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Andrade
authors.affiliation: Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Priyanka P
authors.initials: PP
authors.lastname: Shah-Basak
authors.affiliation: Division of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Manohar
authors.initials: M
authors.lastname: Shroff
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Mahendranath
authors.initials: M
authors.lastname: Moharir
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Ivanna
authors.initials: I
authors.lastname: Yau
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Rand
authors.initials: R
authors.lastname: Askalan
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Daune
authors.initials: D
authors.lastname: MacGregor
authors.affiliation: Section of Neurology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Mubeen F
authors.initials: MF
authors.lastname: Rafay
authors.affiliation: Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.|Child Health Evaluative Sciences Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
authors.forename: Gabrielle A
authors.initials: GA
authors.lastname: deVeber
mesh_terms: D002545:Brain Ischemia / Q000150:complications; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D059906:Neuroimaging / Q000379:methods; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents