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Published online July 20, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e227-e234 (doi:10.1542/peds.2008-3544)
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ARTICLE

Delayed Recognition of Initial Stroke in Children: Need for Increased Awareness

Jayasri Srinivasan, MBBS, FRACPa,b, Steven P. Miller, MDCM, MAS, FRCPCb,c, Thanh G. Phan, MBBS, FRACPd, Mark T. Mackay, MBBS, FRACPa

a Department of Pediatric Neurology, Royal Children's Hospital, Melbourne, Australia
Departments of b Pediatric Neurology
c Pediatrics, British Columbia Children's Hospital, Vancouver, Canada
d Department of Neurosciences, Monash Medical Centre, Melbourne, Australia

OBJECTIVE: The goal was to identify the delays involved in diagnosing pediatric arterial ischemic stroke (AIS), a major cause of morbidity and death in children.

METHODS: Neonates (≤28 days of age) and children with a first presentation of radiologically confirmed AIS between June 1993 and January 2006 were identified retrospectively. The time to diagnosis of AIS (ie, time from clinical onset to radiologic confirmation) was calculated, and factors influencing stroke diagnosis were reviewed.

RESULTS: A total of 107 patients (19 neonates and 88 children) with a diagnosis of AIS were identified. The median time to AIS diagnosis was 87.9 hours for neonates, significantly longer than 24.8 hours for children (P = .0002). Sixty-nine percent of the children with AIS demonstrated a likely cardioembolic cause, and 51 (58%) of the 88 children were inpatients at the time of stroke. The inpatients were seen by a physician more quickly (P < .01) and received a diagnosis of AIS sooner (P < .01). Seventy-six (86%) of the 88 children had a focal neurologic deficit when first seen by a physician. Physicians documented a diagnosis/differential diagnosis for 44 (50%) of 88 children, and they documented a suspicion of AIS for only 23 (26%) of 88 children. The presence of seizures or focal signs was not associated with a quicker time to stroke confirmation.

CONCLUSIONS: The considerable delays in the diagnosis of pediatric AIS are most likely related to the lack of awareness of stroke among medical staff members, despite risk factors and focal signs at presentation.

Key Words: stroke • cerebrovascular disease • cerebral vascular accident

Abbreviations: AIS—arterial ischemic stroke • CT—computed tomographic • ICD—International Classification of Diseases • IQR—interquartile range

Accepted Mar 13, 2009.


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