Emergence of the Primary Pediatric Stroke Center

Abstract

BACKGROUND AND PURPOSE In adult stroke, the advent of thrombolytic therapy led to the development of Primary Stroke Centers able to diagnose and treat patients with acute stroke rapidly. We describe the development of Primary Pediatric Stroke Centers through preparation of participating centers in the Thrombolysis in Pediatric Stroke (TIPS) Trial. METHODS We collected data from the 17 enrolling TIPS centers regarding the process of becoming an acute pediatric stroke center with capability to diagnose, evaluate and treat pediatric stroke rapidly, including use of thrombolytic therapy. RESULTS Prior to 2004 <25% of TIPS sites had continuous twenty-four hour availability of acute stroke teams, MRI capability, or stroke order sets, despite significant pediatric stroke expertise. Following TIPS preparation, >80% of sites now have these systems in place, and all sites reported increased readiness to treat a child with acute stroke. Use of a 1–10 Likert scale on which 10 represented complete readiness, median center readiness increased from 6.2 prior to site preparation to 8.7 at the time of site activation (P=<0.001). CONCLUSIONS Prior to preparing for TIPS, centers interested in pediatric stroke had not developed systematic strategies to diagnose and treat acute pediatric stroke. TIPS trial preparation has resulted in establishment of pediatric acute stroke centers with clinical and system preparedness for evaluation and care of children with acute stroke, including use of a standardized protocol for evaluation and treatment of acute arterial stroke in children that includes use of intravenous tPA.

Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

“…No significant differences were found in any group after adjustment for site, age, admission National Institutes of Health Stroke Scale score, and blood glucose, with respect to the rate of symptomatic intracerebral hemorrhage, modified Rankin Scale score on discharge, discharge disposition, 90-day modified Rankin Scale score, or 90-day mortality when comparing weekend and weekday admissions. 23 These 2 studies suggest that organization of 24 Initiatives to increase readiness of hospitals that treat children with stroke and to standardize pediatric stroke protocols may help to eliminate the weekend effect in children.…”

Susceptibility-Weighted Imaging in Pediatric Arterial Ischemic Stroke: A Valuable Alternative for the Noninvasive Evaluation of Altered Cerebral Hemodynamics

“…Although the benefit of thrombolytic therapy in PAIS has yet to be demonstrated in prospective clinical trials, retrospective studies show that at least a subset of children with AIS may potentially benefit from it. 21,22 Several tertiary pediatric centers have developed standardized systematic strategies to diagnose and treat PAIS, for participation in the ongoing Thrombolysis in Pediatric Stroke trial. 21,22 Ischemic penumbra can be depicted as a mismatch between reduced perfusion and normal diffusion by combining PWI and DWI/DTI.…”

“…21,22 Several tertiary pediatric centers have developed standardized systematic strategies to diagnose and treat PAIS, for participation in the ongoing Thrombolysis in Pediatric Stroke trial. 21,22 Ischemic penumbra can be depicted as a mismatch between reduced perfusion and normal diffusion by combining PWI and DWI/DTI. 23 In children, however, the routine application of PWI outside research protocols and tertiary care centers is still limited.…”

Metilen Tetrahidrofolat Reduktaz A1298C ve Plazminojen Aktivator Inhibitoru-1 4G/5G Polimorfizmli Cocuk Hastada Olümcül Akut Arteriyel Iskemik Inme

“…Bununla birlikte deneyimli merkezlerde dikkatli bir şekilde kullanılabileceği bildirilmektedir (12). Ellis ve ark 2012 yılında yaptığı literatür taramasında 34 çocukta uygulanan endovasküler yaklaşımları özetlemiştir.…”