FV 257. Munich Early Recognition of Childhood Stroke—More than a FAST Screening Tool

Background: Acute neurologic symptoms belong to the most common reasons for a (self-)admission to a pediatric emergency department. Disorders reach from less time critical situations (i.e., tension-type headache) to disorders that require an urgent management (i.e., childhood stroke). Therefore, a correct triage by (para)medical professionals and an accurate early medical assessment is pivotal for prognosis. In this respect, patients presenting with brain attack symptoms represent are a very important cohort. The term brain attack comprises any acute focal neurological symptoms representing a sudden cerebral dysfunction. Although the vast majority of adults presenting with brain attack do suffer stroke, stroke mimics are by far more commonly the reason for a pediatric brain attack. Stroke mimics include migraine, seizure, Bell’s palsy, and somatoform disorders. Childhood stroke is a rare condition, but it constitutes the most time critical of all neurologic emergencies and comes along with a high impact on the life of patients and their families. The clinical suspicion of a childhood stroke has to be followed by prompt neuroimaging to confirm the diagnosis, to allow to establish a contact to or a transfer to a specialized pediatric stroke center, as well as therapeutic options only applicable during a short time window (i.e., thrombolysis, thrombectomy). Even if no intervention is indicated in the first instant, patients may profit of a specialized, interdisciplinary management starting as early as possible. In clinical routine, significant delays from the first medical contact to the confirmation of the diagnosis still represent a major issue.

Objectives: Regarding adult stroke several well-studied stroke screening tools exist. As by today no such instrument has been implemented for childhood stroke. As for adults, children, and adolescents, the Face–Arm–Speech–Time test has often been recommended. Easily and fast to assign, it is—in line with other bed-side tests (z.B. ROSIER)—not that sensitive in child as in adulthood. Therefore, adaptation of the preexisting adult tools is necessary. Based on recent research results our working group endeavored to conceptualize a tool to facilitate early recognition of childhood stroke.

Methods and Results: Our LMU working group, lead by Lucia Gerstl, conceptualized the pocket card “Munich Early Recognition of Childhood Stroke (MERCS).” With respect to the differences between adult and childhood stroke, we designed a pocket card comprising three groups of items: (1) history, (2) examination, and (3) relevant symptoms and signs of hemorrhagic stroke. During work in progress, it revealed that MERCS should not only be understood as a sole stroke recognition tool but much more used as a brain attack screening instrument in a more general way. After all, less time critical neuropediatric disorders are not less important to the patient and require a timely adequate management, too.

Conclusion: MERCS could serve as a valuable tool in the evaluation of pediatric patients presenting with a brain attack if its use could support to a standardized and structured assessment. If MERCS helps facilitate the decision if a patient requires an urgent second look by a specialist in pediatric neurology and/or a prompt-specific diagnostic work-up, we achieved our goal. A first personal feedback in our institution is decidedly positive, in particular, in regard to its positive effect on the awareness of childhood brain attack.