Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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Essentials Appropriate, theory‐based education has been linked to improved patient and system outcomes.Literature regarding theory‐based education in thrombosis and hemostasis is extremely limited.Current literature describes teaching strategy in single centers vs. impact of underlying theory.Collaborative efforts are required to make recommendations regarding optimization of education. Prior work regarding patient education has identified the importance of using learning theory and educational models to develop and deliver content that will improve patient outcomes. Current literature appears to examine implementation of teaching strategies without clear identification of educational principles. This review aimed to identify educational principles and theory currently utilized in the planning and delivery of patient education in disorders of thrombosis and hemostasis. The majority of articles reviewed evaluated the impact of educational interventions on patient outcomes; links between educational principles and changes in outcomes was lacking. Few articles clearly referenced theory in development of patient education; fewer focussed on the population of interest. The lack of literature demonstrates the need for multi‐center collaborative research aimed at generation of an improved level of evidence regarding the most effective theoretical framework for the development, delivery and evaluation of patient education for patients with disorders of thrombosis and hemostasis. Once a theoretical framework for patient education is developed and tested, the unique contribution of patient education to both knowledge and clinical outcomes can be robustly evaluated.

Background: The overall incidence of venous thromboembolism (VTE) has steadily increased in the pediatric population, largely due to rising utilization of central venous catheters (CVCs). Anticoagulation is the mainstay therapy for pediatric CVC-related VTE. Due to paucity of prospective data, optimal duration of anticoagulation therapy has yet to be defined and current recommendations for anticoagulation duration are largely extrapolated from data in adult patients with lower extremity deep vein thrombosis (DVT) and small, non-randomized studies. The objective of this study is to report outcomes of a risk-stratified anticoagulation protocol in a cohort of pediatric patients with CVC-related VTE followed at our center. Methods: We performed a retrospective analysis of a prospectively maintained institutional thrombosis patient registry created using Research Electronic Data Capture (REDCap). We identified all patients with an objectively confirmed catheter-related VTE who were followed at our institution over a 5-year period (2012-2017). Patients were managed according to an institutional risk-stratified protocol in which patients received therapeutic enoxaparin for a maximal duration of 3 months with assessment of radiologic response at 6 weeks and 3 months. After 6 weeks of therapy, enoxaparin was discontinued if the CVC had been removed, or decreased to prophylactic dosing if the CVC is still present in low risk patients with non-recurrent CVC-related DVT who had complete radiologic thrombus resolution and no major thrombophilia. We compared patients with complete resolution at 6 weeks to those who did not have complete resolution at 6 weeks with respect to demographics, relevant clinical characteristics, baseline laboratory measurements, anticoagulation quality measurements, and key outcome measures (frequency of a composite of recurrent symptomatic radiologically-confirmed DVT, pulmonary embolism (PE) and/or paradoxical embolism, frequency of post-thrombotic syndrome (PTS), and frequency of anticoagulation-related major bleeding and/or clinically relevant non-major bleeding). Data was compared using the Mann-Whitney U test or Fisher exact test as appropriate. Two-tailed p value less than 0.05 was considered statistically significant. Results: A total of 137 patients who developed a CVC-related VTE at our institution during the study period were included in the analysis. Of 137 patients, 70 (51%) patients had complete radiologic resolution at 6 weeks, while 26% had partial resolution, 20% had non-resolution and 3% were noted to have radiologic progression. At 3 months, 38% of patients had complete resolution, 24% had partial resolution, 21% had non-resolution and 7% showed radiologic progression. Patients who had complete resolution at 6 weeks were largely similar in their characteristics to those who did not show complete resolution at 6 weeks (Table 1). The frequency of thrombophilia was not different between the two groups and none of the patients were found to have major thrombophilia (Table 1). However, the frequency of vena cava involvement was significantly higher and the time to achieve therapeutic anticoagulation was significantly longer in patients who did not show complete resolution at 6 weeks (Table 1). The frequency of recurrent clinically symptomatic DVT, PE and/or paradoxical embolism in patients with complete radiologic resolution at 6 weeks [5/70 (7%)] was similar to those who did not show complete radiologic resolution at 6 weeks [9/67 (13%)] (p=0.27). The frequency of PTS was significantly higher in patients who did not show complete radiologic resolution at 6 weeks [5/60 (8%)] compared to patients with complete radiologic resolution at 6 weeks [0/64 (0%)] (p=0.02). The frequency of anticoagulation-related bleeding events was similar in patients with complete radiologic resolution at 6 weeks [6/70 (9%)] and patients who did not have complete radiologic resolution at 6 weeks [6/67 (9%)] (p=1.00). Conclusion: Our study suggests that pediatric patients with CVC-related DVT who demonstrate complete radiologic resolution after 6 weeks of anticoagulation represent a lower risk patient group that appears to have favorable outcomes. Vena cava involvement and longer time to achieve therapeutic anticoagulation may be associated with suboptimal radiologic response at 6 weeks. Larger prospective studies are needed to confirm our results. Disclosures No relevant conflicts of interest to declare.

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