University of Zurich, Switzerland.
Swiss Med Wkly. 2011 Oct 19;141:w13281. doi: 10.4414/smw.2011.13281. eCollection 2011.
QUESTIONS UNDER STUDY/PRINCIPLES: After arterial ischemic stroke (AIS) an early diagnosis helps preserve treatment options that are no longer available later. Paediatric AIS is difficult to diagnose and often the time to diagnosis exceeds the time window of 6 hours defined for thrombolysis in adults. We investigated the delay from the onset of symptoms to AIS diagnosis in children and potential contributing factors.
We included children with AIS below 16 years from the population-based Swiss Neuropaediatric Stroke Registry (2000-2006). We evaluated the time between initial medical evaluation for stroke signs/symptoms and diagnosis, risk factors, co-morbidities and imaging findings.
A total of 91 children (61 boys), with a median age of 5.3 years (range: 0.2-16.2), were included. The time to diagnosis (by neuro-imaging) was <6 hours in 32 (35%), 6-12 hours in 23 (25%), 12-24 hours in 15 (16%) and >24 hours in 21 (23%) children. Of 74 children not hospitalised when the stroke occurred, 42% had adequate outpatient management. Delays in diagnosis were attributed to: parents/caregivers (n = 20), physicians of first referral (n = 5) and tertiary care hospitals (n = 8). A co-morbidity hindered timely diagnosis in eight children. No other factors were associated with delay to diagnosis. A total of 17 children were inpatients at AIS onset.
One-third of children with AIS were diagnosed within six hours. Diagnostic delay was predominately caused by insufficient recognition of stroke symptoms. Increased public and expert awareness and immediate access to diagnostic imaging are essential. The ability of parents/caregivers and health professionals to recognise stroke symptoms in a child needs to be improved.
研究问题/原则：急性缺血性脑卒中（AIS）后，早期诊断有助于保留治疗方案，而这些方案在成人溶栓的 6 小时时间窗之后就不再适用。儿科 AIS 很难诊断，而且通常从症状发作到诊断的时间超过了成人溶栓的 6 小时时间窗。我们研究了儿童 AIS 诊断的延迟时间及其潜在的影响因素。
我们纳入了来自基于人群的瑞士神经儿科卒中登记处（2000-2006 年）的 16 岁以下 AIS 患儿。我们评估了从首次评估到卒中症状/体征到诊断、危险因素、合并症和影像学发现的时间。
共纳入 91 例（61 例男性）患儿，中位年龄为 5.3 岁（范围：0.2-16.2 岁）。32 例（35%）患儿的诊断时间（通过神经影像学检查）<6 小时，23 例（25%）患儿为 6-12 小时，15 例（16%）患儿为 12-24 小时，21 例（23%）患儿>24 小时。在卒中发生时未住院的 74 例患儿中，42%有充分的门诊管理。诊断延迟归因于：父母/照顾者（20 例）、首次转诊医生（5 例）和三级医院（8 例）。8 例患儿的合并症阻碍了及时诊断。没有其他因素与诊断延迟有关。17 例患儿在 AIS 发病时为住院患者。
三分之一的 AIS 患儿在 6 小时内得到诊断。诊断延迟主要是由于对卒中症状识别不足所致。提高公众和专家的认识并能立即获得诊断性影像学检查至关重要。需要提高父母/照顾者和卫生专业人员识别儿童卒中症状的能力。
