Neuropediatrics 2006; 37 - TP58
DOI: 10.1055/s-2006-945651

DIAGNOSTIC DELAYS IN ACUTE PEDIATRIC ARTERIAL ISCHEMIC STROKE

M Rafay 1, AM Pontigon 1, J Chiang 1, M Adams 1, A Jarvis 1, F Silver 2, G deVeber 1
  • 1Hospital for Sick Children, Toronto, ON, Canada
  • 2University Health Network, Toronto, ON, Canada

Objectives: Prompt and accurate diagnosis of paediatric arterial ischemic stroke (AIS) presents challenges. We sought to determine the meaningful components comprising diagnostic delay and major inaccuracies in diagnosing paediatric AIS.

Methods: Consecutive children with a confirmed diagnosis of AIS, aged 1-month to18-years, admitted to the Hospital for Sick Children from January 1992 to December 2004 were studied. Data on times of symptom onset, hospital emergency room (ER) arrival, initial neuroimaging study and stroke diagnosis were recorded. Of the 230 children enrolled, preliminary analysis on 155 children is reported. The complete cohort will be presented at the meeting.

Results: 155 children, 95-males with AIS were studied. Of the 155 children, 111 (72%) children had stroke as out-patients, of whom 38 were brought directly to our hospital emergency room (ER) and 73 were referred from another ER. In 44 (28%), stroke occurred in our hospital. In 85 (55%) children, the mean overall interval from symptom onset to stroke diagnosis was 41.8 hours (range0.50–961 hour). Interval from symptom onset to ER arrival was available in 69, mean 20.8 hours (range 0.33–146 hours; 28% <3-hours; 20% between 3–6 hours; 23% between 6–24 hours and 29% >24- hours). Mean interval from arrival in ER to been seen by ER physician was 52 minutes (range 12 minutes-15.8 hours). Stroke was suspected in less than half (42%), common other diagnoses being seizures, Todd's paralysis, intracranial bleed or tumour, traumatic contusion, Bell's palsy and migraine. In 83 of the 155(53%) with available data, mean interval to first neuroimaging from symptom onset was 16.4 hours (range 0.50–99.8 hours) and from ER arrival was 10.9 hours (range 1.35–106.8 hours). Initial neuroimaging was head CT in 94%. Initial CT missed the diagnosis in 39%.

Conclusions: In children with stroke, significant diagnostic time delays including both pre and in-hospital delays and diagnostic inaccuracies exist. Efforts to reduce these delays can accelerate and optimize the management of stroke in children.