Srinivasan Jayasri, Miller Steven P, Phan Thanh G, Mackay Mark T
Department of Paediatric Neurology, Children's Neuroscience Centre, Royal Children's Hospital, Melbourne, Australia.
Pediatrics. 2009 Aug;124(2):e227-34. doi: 10.1542/peds.2008-3544. Epub 2009 Jul 20.
The goal was to identify the delays involved in diagnosing pediatric arterial ischemic stroke (AIS), a major cause of morbidity and death in children.
Neonates (<or=28 days of age) and children with a first presentation of radiologically confirmed AIS between June 1993 and January 2006 were identified retrospectively. The time to diagnosis of AIS (ie, time from clinical onset to radiologic confirmation) was calculated, and factors influencing stroke diagnosis were reviewed.
A total of 107 patients (19 neonates and 88 children) with a diagnosis of AIS were identified. The median time to AIS diagnosis was 87.9 hours for neonates, significantly longer than 24.8 hours for children (P = .0002). Sixty-nine percent of the children with AIS demonstrated a likely cardioembolic cause, and 51 (58%) of the 88 children were inpatients at the time of stroke. The inpatients were seen by a physician more quickly (P < .01) and received a diagnosis of AIS sooner (P < .01). Seventy-six (86%) of the 88 children had a focal neurologic deficit when first seen by a physician. Physicians documented a diagnosis/differential diagnosis for 44 (50%) of 88 children, and they documented a suspicion of AIS for only 23 (26%) of 88 children. The presence of seizures or focal signs was not associated with a quicker time to stroke confirmation.
The considerable delays in the diagnosis of pediatric AIS are most likely related to the lack of awareness of stroke among medical staff members, despite risk factors and focal signs at presentation.
本研究旨在确定小儿动脉缺血性卒中（AIS）诊断过程中的延误情况，AIS是儿童发病和死亡的主要原因。
回顾性纳入1993年6月至2006年1月首次出现经放射学证实的AIS的新生儿（年龄≤28天）和儿童。计算AIS的诊断时间（即从临床发病到放射学确诊的时间），并分析影响卒中诊断的因素。
共确诊107例AIS患者（19例新生儿和88例儿童）。新生儿AIS诊断的中位时间为87.9小时，显著长于儿童的24.8小时（P = 0.0002）。69%的AIS患儿可能存在心源性栓塞病因，88例患儿中有51例（58%）在卒中发生时为住院患者。住院患者由医生诊治的速度更快（P < 0.01），AIS诊断也更早（P < 0.01）。88例患儿中有76例（86%）初诊时存在局灶性神经功能缺损。医生为88例患儿中的44例（50%）记录了诊断/鉴别诊断，而仅为88例患儿中的23例（26%）记录了AIS的怀疑。癫痫发作或局灶性体征的存在与卒中确诊时间的缩短无关。
小儿AIS诊断的显著延误很可能与医务人员对卒中缺乏认识有关，尽管发病时存在危险因素和局灶性体征。
