Although stroke typically occurs only in elderly patients, this condition can strike infants, children and young adults. For optimal recovery, members of the emergency department, radiology and other departments must work quickly to diagnose and treat pediatric stroke. As a result, many hospitals are now implementing pediatric acute stroke teams.

In a new study published in the July edition of the American Heart Association's journal Stroke, researchers characterized the final diagnosis in children with brain attacks in hospitals that use pediatric stoke protocol. The research team also evaluate the time to neuroimaging and neurological evaluation, the expedience of which leads to optimal recovery.

Only 5 children per 100,000 suffer a stroke each year — approximately 3,000 children and young adults in the United States had a stroke in 2004. However, this brain attack is one of the top 10 causes of death for children between the ages of 1 and 19.

Misdiagnosis or delayed diagnosis of pediatric stoke is still common and can have catastrophic consequences. Currently, between 20 and 40 percent of children who have a stroke die, and 60 percent of those who survive suffer permanent neurological deficits. Hemiparesis and hemiplegia are the most common neurological effects.

Led by Lori Jordan, M.D., Ph.D., assistant professor of pediatrics and neurology at Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, Tennessee, researchers gathered clinical and demographic information from medical records and a QI database.

They looked at records for patients aged 20 years or younger who presented between Aprill 2011 and October 2014 to Vanderbilt's pediatric emergency department that had pediatric stroke protocol activation already in place. Stroke protocol activation means a neurology resident evaluates the child within 15 minutes of presentation, and that urgent MRI is immediately available.

Using this stroke protocol activation method for 124 children presenting stroke-like symptoms, the research team found that 30 patients had suffered strokes and two had TIAs. Seventeen patients had nonstroke neurological emergencies, such as meningitis/encephalitis or intracranial neoplasm. Forty-six patients were healthy children. Other diagnosis included complex migraine and seizure.

The researchers found the median time from consultation to neurologist at-bedside was 7 minutes, and the median time between emergency department arrival and consultation with a pediatric neurologist was 28 minutes.

MRI was the first study performed in 76 percent of cases. All but one child received urgent neuroimaging. The median time from emergency department arrival to MRI was 94 minutes. The research team found a median time to computed tomography (CT) of 59 minutes.

This study shows that implementing pediatric acute stroke teams can provide rapid evaluation, diagnosis and treatment time for pediatric patients presenting stroke-like symptoms in a way that could prevent death and disability resulting from childhood stroke.