Time Lag to Diagnosis of Stroke in Children

Gabis, Lidia V.; Yangala, Ravi; Lenn, Nicholas J.

doi:10.1542/peds.110.5.924

Cited by 157 publications

(133 citation statements)

References 7 publications

Supporting

Mentioning

107

Contrasting

Unclassified

Order By: Relevance

“…The time to establishing a diagnosis of arterial ischemic stroke (AIS) in children averages >24 hours and is even longer in neonates [111][112][113][114][115]. Both pre-hospital and inhospital delays have been identified.…”

Section: Pediatric Strokementioning

confidence: 99%

“…Both pre-hospital and inhospital delays have been identified. A lack of recognition of stroke symptoms in children may contribute to a >24-h delay from symptom onset to the time of seeking medical treatment that has been seen in some studies [112,116]. Adult risk factors that are typically associated with stroke (including hypertension, hyperlipidemia, diabetes, and atherosclerosis) are rare in pediatrics.…”

Section: Pediatric Strokementioning

confidence: 99%

See 1 more Smart Citation

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

View full text Add to dashboard Cite

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

show abstract

Section: Pediatric Strokementioning

confidence: 99%

Section: Pediatric Strokementioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

View full text Add to dashboard Cite

show abstract

“…Lengthy delay in diagnosis of stroke in children is common. 55 Children with suspected stroke should be seen urgently at a tertiary care pediatric care center with access to a multidisciplinary team headed by a pediatric neurologist. All children require measurement of coagulation parameters, blood cell counts, and routine blood work as well as a detailed prothrombotic work-up.…”

Section: Diagnosis and Investigationsmentioning

confidence: 99%

“…Limited access to timely treatment is highlighted by a study from an experienced stroke center where fewer than 25% of pediatric cases were diagnosed within the 3-6 hour time window. 55 Improved education of primary care physicians and the public are required to overcome this delay to diagnosis. The broad differential diagnosis for acute neurological deficits in children requires rapid but definitive neuroimaging protocols to confirm infarction and arterial occlusion.…”

Section: Hyperacute Treatment: Thrombolysismentioning

confidence: 99%

Therapeutic approaches and advances in pediatric stroke

Kirton

deVeber

2006

NeuroRX

View full text Add to dashboard Cite

Summary:Evidence-based therapeutic interventions for pediatric ischemic cerebrovascular disease are beginning to emerge. The primary therapeutic target is usually the pathological prothrombotic disturbance that underlies the majority of pediatric stroke. A battle between anticoagulation and anti-platelet therapies continues to provide controversy and is the inspiration for upcoming randomized trials. Supportive care and neuroprotective strategies are an important consideration in children with stroke. Attempts to determine the safety of acute thrombolytic interventions are also underway. Finally, unique medical and surgical treatments for specific diseases leading to stroke in children continue to evolve. After briefly summarizing the epidemiology, pathophysiology, diagnosis, and outcomes of ischemic strokes in children, treatment approaches and alternatives will be reviewed in detail with emphasis placed on current areas of controversy and future directions for clinical research.

show abstract

“…The diagnosis of ischaemic stroke in children is difficult. A recent study documented a mean delay of 34.5 hours between initial symptoms and first encounter with a health provider in non-neonates with arterial ischaemic stroke (AIS), and 42.8 hours until initial imaging (Gabis et al 2002). Causes and risk factors are diverse and differ substantially from those in adults (DeVeber 2003a).…”

mentioning

confidence: 99%

Diagnostic pitfalls in paediatric ischaemic stroke

Braun¹,

Kappelle

Kirkham

et al. 2006

Develop Med Child Neuro

View full text Add to dashboard Cite

Diagnosing ischaemic stroke and determining its cause is difficult in children. Both are important for selection of treatment and prediction of outcome. This study explored the diagnostic changes that lead to a delay in the correct diagnosis of paediatric stroke. Case histories of 45 children with ischaemic stroke (31 males, 14 females; median age 6y; age range 2mo–16y) were retrospectively reviewed. The initial clinical diagnosis, based on the interpretation of presenting symptoms, was compared with the final aetiological stroke diagnosis after completion and review of diagnostic work‐up. The type of diagnostic change, consequent time delay until correct diagnosis, reasons for change of diagnosis, and alterations to management were evaluated. Twenty‐four diagnostic changes were identified; 19 in ‘primary stroke diagnosis’ (symptoms initially not attributed to stroke), and five in ‘aetiological diagnosis’ (incorrect initial determination of type or cause of stroke). The median interval between initial and final diagnosis was 7 days (3h–2y). The change in diagnosis led to therapeutic alterations in 17 patients. Risk factors for childhood stroke differ from those in adults. Stroke is frequently not recognized as the cause of the child's symptoms, and the correct determination of stroke aetiology takes time. We recommend that children with stroke be evaluated in a centre with expertize, using standardized diagnostic protocols and careful follow‐up.

show abstract

Time Lag to Diagnosis of Stroke in Children

Cited by 157 publications

References 7 publications

Pediatric Neurocritical Care

Pediatric Neurocritical Care

Therapeutic approaches and advances in pediatric stroke

Diagnostic pitfalls in paediatric ischaemic stroke

Contact Info

Product

Resources

About