儿科中风中心的出现：溶栓治疗儿科中风试验的影响。
Emergence of the primary pediatric stroke center: impact of the thrombolysis in pediatric stroke trial.
机构信息
From the Department of Neurology, Children's Hospital Colorado, Aurora (T.J.B.); Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, MA (M.J.R.); Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.d.V.), Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada (A.K.); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, and BloodCenter of Wisconsin (J.C.G.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.K.C.); Department of Pediatrics, Dell Children's Medical Center, Austin, TX (C.A.H.), Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia (R.N.I.); Department of Neurology, Memorial Hermann Hospital, Houston, TX (J.C.G.); Division of Pediatric Neurology, Vanderbilt University, Nashville, TN (L.C.J.); Department of Neurology, Primary Children's Medical Center, Salt Lake City, UT (S.B.); Department of Neurology, Cleveland Clinic, OH (N.R.F.); Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas TX (M.M.D.); Department of Neurology, Stanford University, CA (J.E.); Department of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX (M.T.); Department of Neurology, Columbia University Medical Center, New York, NY (S.S.); Division of Child Neurology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, PA (D.D.C.); Division of Pediatric Hematology/Oncology, Department of Pediatrics, Mass General Hospital for Children, and Massachusetts General Hospital, Boston (E.F.G.); Department of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada (H.J.M.); Departments of Pediatrics and Neurology, Yale-New Haven Children's Hospital, CT (L.A.B.); Department of Neurology, Seattle Children's Hospital, WA (K.S., C.A.-L.); and Department of Neurology, University of Washington, Seattle (C.A.-L.).
出版信息
Stroke. 2014 Jul;45(7):2018-23. doi: 10.1161/STROKEAHA.114.004919. Epub 2014 Jun 10.
BACKGROUND AND PURPOSE
In adult stroke, the advent of thrombolytic therapy led to the development of primary stroke centers capable to diagnose and treat patients with acute stroke rapidly. We describe the development of primary pediatric stroke centers through preparation of participating centers in the Thrombolysis in Pediatric Stroke (TIPS) trial.
METHODS
We collected data from the 17 enrolling TIPS centers regarding the process of becoming an acute pediatric stroke center with capability to diagnose, evaluate, and treat pediatric stroke rapidly, including use of thrombolytic therapy.
RESULTS
Before 2004, <25% of TIPS sites had continuous 24-hour availability of acute stroke teams, MRI capability, or stroke order sets, despite significant pediatric stroke expertise. After TIPS preparation, >80% of sites now have these systems in place, and all sites reported increased readiness to treat a child with acute stroke. Use of a 1- to 10-Likert scale on which 10 represented complete readiness, median center readiness increased from 6.2 before site preparation to 8.7 at the time of site activation (P≤0.001).
CONCLUSIONS
Before preparing for TIPS, centers interested in pediatric stroke had not developed systematic strategies to diagnose and treat acute pediatric stroke. TIPS trial preparation has resulted in establishment of pediatric acute stroke centers with clinical and system preparedness for evaluation and care of children with acute stroke, including use of a standardized protocol for evaluation and treatment of acute arterial stroke in children that includes use of intravenous tissue-type plasminogen activator.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT01591096.
背景与目的
在成人中风中，溶栓治疗的出现导致了能够快速诊断和治疗急性中风患者的初级中风中心的发展。我们描述了通过参与 Thrombolysis in Pediatric Stroke（TIPS）试验的中心的准备工作，发展初级儿科中风中心的情况。
方法
我们从参与 TIPS 试验的 17 个中心收集了有关成为具有快速诊断、评估和治疗儿科中风能力的急性儿科中风中心的准备过程的数据，包括使用溶栓治疗。
结果
在 2004 年之前，尽管有大量的儿科中风专业知识，但 TIPS 站点中只有 <25% 的站点具有 24 小时连续的急性中风团队、MRI 能力或中风医嘱集。在 TIPS 准备之后，现在超过 80%的站点都有了这些系统，并且所有站点都报告说，它们对治疗急性中风儿童的准备更加充分。使用 1-10 分的李克特量表，其中 10 表示完全准备就绪，中位数中心准备程度从准备前的 6.2 分提高到站点激活时的 8.7 分（P≤0.001）。
结论
在准备参与 TIPS 试验之前，对儿科中风感兴趣的中心尚未制定系统的策略来诊断和治疗急性儿科中风。TIPS 试验准备工作导致了儿科急性中风中心的建立，这些中心在评估和护理急性中风儿童方面具有临床和系统准备，包括使用标准化的方案来评估和治疗儿童急性动脉性中风，包括使用静脉内组织型纤溶酶原激活剂。
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