Shack Melissa, Andrade Andrea, Shah-Basak Priyanka P, Shroff Manohar, Moharir Mahendranath, Yau Ivanna, Askalan Rand, MacGregor Daune, Rafay Mubeen F, deVeber Gabrielle A
Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
Neurology Section, Department of Paediatrics, University of Western Ontario, London, ON, Canada.
Dev Med Child Neurol. 2017 Jan;59(1):31-37. doi: 10.1111/dmcn.13214. Epub 2016 Aug 4.
We aimed to evaluate whether an institutional acute stroke protocol (ASP) could accelerate the diagnosis and secondary treatment of pediatric stroke.
We initiated an ASP in 2005. We compared 209 children (125 males, 84 females; median age 4.8y, interquartile range [IQR] 1.2-9.3y, range 0.09-17.7y) diagnosed with arterial ischemic stroke 'pre-protocol' (1992-2004) to 112 children (60 males, 52 females; median age 5.8y, IQR 1.0-11.4y, range 0.08-17.7y) diagnosed 'post-protocol' (2005-2012) for time-to-diagnosis, mode of diagnostic imaging, and time-to-treatment with antithrombotic medication (aspirin or anticoagulants).
Overall, the interval from symptom onset to diagnosis was similar post-protocol compared to pre-protocol (20.3 vs 22.7h; p=0.109), although mild strokes (Pediatric National Institute of Health Stroke Scale [PedNIHSS] 0-4), were diagnosed faster post-protocol (12.1 vs 36.3h; p=0.003). Magnetic resonance imaging (MRI) was the initial diagnostic modality more often post-protocol (25% vs 1.4%; p<0.001). Initial MRI was more accurate for diagnosing stroke than initial CT (100% vs 47%; p<0.001) with similar time-to-diagnosis. The proportion of children receiving antithrombotic medication within 24 hours doubled in the post-protocol period (83% vs 36%; p<0.001).
A pediatric ASP accelerated time-to-treatment, time-to-diagnosis in children with subtle strokes, and increased MRI as initial imaging, reducing the need for computed tomography. Implementing optimized ASPs can facilitate more timely access to diagnosis and management of children with acute stroke.
我们旨在评估机构急性卒中方案（ASP）是否能加速儿童卒中的诊断和二级治疗。
我们于2005年启动了一项急性卒中方案。我们将209例在“方案前”（1992 - 2004年）被诊断为动脉缺血性卒中的儿童（125例男性，84例女性；中位年龄4.8岁，四分位间距[IQR]1.2 - 9.3岁，范围0.09 - 17.7岁）与112例在“方案后”（2005 - 2012年）被诊断的儿童（60例男性，52例女性；中位年龄5.8岁，IQR 1.0 - 11.4岁，范围0.08 - 17.7岁）进行比较，比较诊断时间、诊断成像方式以及抗血栓药物（阿司匹林或抗凝剂）治疗时间。
总体而言，与方案前相比，方案后从症状发作到诊断的间隔相似（20.3小时对22.7小时；p = 0.109），尽管轻度卒中（儿童国立卫生研究院卒中量表[PedNIHSS]为0 - 4）在方案后诊断更快（12.1小时对36.3小时；p = 0.003）。磁共振成像（MRI）在方案后更常作为初始诊断方式（25%对1.4%；p < 0.001）。初始MRI诊断卒中比初始CT更准确（100%对47%；p < 0.001），且诊断时间相似。在方案后时期，24小时内接受抗血栓药物治疗的儿童比例翻倍（83%对36%；p < 0.001）。
儿科急性卒中方案缩短了治疗时间，缩短了轻度卒中儿童的诊断时间，并增加了MRI作为初始成像的应用，减少了对计算机断层扫描的需求。实施优化的急性卒中方案可促进更及时地对急性卒中儿童进行诊断和管理。
