AISArterial RESULTS 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).
Aim: Since the start of the COVID-19 pandemic, there have been many changes in the presenting complaints in paediatric emergency departments (EDs). We sought to characterise the impact of the COVID-19 pandemic on bicycle-related injuries in children presenting to a tertiary care paediatric ED. Methods: We conducted a descriptive, cross-sectional study of ED visits to a large urban tertiary children's hospital, comparing March to October 2020 (the study period) to the same date range 2 years prior (i.e. March to October 2018-2019). We included children 0-17.99 years presenting for a bicycle-related injury. We compared absolute visit counts of bike injuries per month, demographics, triage acuity, injury type and disposition.Results: A total of 1215 bike-related visits were analysed. There were 234 presentations in 2018 (March to October), 305 in 2019, and 676 in 2020. Overall, the mean age was 9.5 years (standard deviation 5.5-13.5), there were 67% males, median Canadian Emergency Department Triage and Acuity Scale score was 3 (interquartile range 3-4) and the most common injuries were fractures (n = 471, 38.8%). There were significantly more bike injuries presenting to the ED per month in the COVID group, 33.7(17.9) versus 84.5(61.4) (two-tailed P value = 0.041). There was no statistical difference in 'severe injuries' pre-versus post-COVID (odds ratio 0.815 (95% confidence interval 0.611-1.088), P = 0.165). Conclusion: There was a significant increase in bicycle-related injuries presenting to our ED during the pandemic, compared to previous years. Evaluating these trends will allow for the exploration of harm reduction strategies for preventing future bicycle-related injuries.
Introduction: In pediatric stroke, reported median delays from symptom onset to imaging diagnosis are 16-24hrs. This results in delayed treatment initiation. The impact of an Acute Stroke Protocol in pediatric hospitals has not been reported. Such a program was implemented at SickKids in 2005. The current study measured the impact of this protocol on delays to diagnosis and initiation of antithrombotic agents. Methods: We compared time to diagnosis and treatment in children (age 1mo-18yrs) with acute AIS diagnosed after stroke protocol implementation (‘post-protocol’ from 2005-2012), to 209 children diagnosed ‘pre-protocol’ 1992-2004. Focused health record reviews abstracted intervals from symptom onset to diagnosis and to initiation of first antithrombotic treatment. We statistically compared time intervals in pre and post-protocol cohorts. Results: Among 118 children diagnosed post-protocol (75 outpatient and 43 inpatient strokes), median age was 5.8 years with 65 males. Median delay from symptom onset to diagnosis in post-protocol children was similar to pre-protocol children, for all strokes (19.9hrs vs 22.7hrs respectively; p=0.24), outpatient (22.4hrs vs 29.1hrs; p=0.12) and inpatient strokes (12.8hrs vs 14.6hrs; p=0.92). The main contributors to diagnosis beyond 6 hrs were delays in initial neuroimaging (25% of delays) and false-negative neuroimaging results (19% of delays) in CT scan as first test. The interval from diagnosis to antithrombotic treatment was more frequently within 24 hours for children treated post-protocol (55.1% vs 18.7% pre-protocol;p<0.0001) and in post-protocol children this interval was median 4.5 hrs (IQR 1.9-16.6). Also children with inpatient strokes more frequently received antithrombotic agents post-protocol (58% vs 35% pre-protocol;p=0.031). The types of antithrombotic treatments were similar (p=0.337). Conclusions: The implementation of an Acute Stroke Protocol in our children’s hospital reduced the time to initiation of antithrombotic treatment. As thrombolysis and other hyper-acute treatments become available, the implementation of institutional Acute Stroke Protocols in children’s hospitals will be an important strategy to increase access to these therapies for children with AIS.
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