Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Division of Neurology, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
Pediatr Neurol. 2018 Mar;80:35-41. doi: 10.1016/j.pediatrneurol.2017.10.005. Epub 2017 Oct 31.
Acute stroke protocols improve delivery of care but it is unclear whether these resource intensive protocols are able to differentiate stroke from mimics in children. The aim of this study is to describe our institution's experience with stroke mimics identified through our pediatric stroke clinical pathway (PSCP).
The PSCP was implemented in our level 1 pediatric emergency department in June 2014 for children aged one month to 18 years. For patients managed using the PSCP from June 2014 to December 2016, demographic and clinical data were compared for patients diagnosed with stroke or a stroke mimic.
A total of 59 children were evaluated with the PSCP. Fourteen children were identified as having a stroke and 45 children had stroke mimics. The most common stroke mimics were functional neurological disorders (20.0%), transient neurological deficits (17.8%), migraine (15.6%), and seizure (11.1%). Patient demographics and time to neuroimaging did not differ between patients with and without stroke. Vomiting was commonly reported by patients with stroke (odds ratio: 4.00, 95% confidence interval: 1.12 to 14.35), whereas weakness was not (odds ratio: 0.7, 95% confidence interval: 0.07 to 0.90), but the physical examination did not differ between patients with and without stroke.
The PSCP ensures timely evaluation of patients presenting with neurological deficits but fails to reliably differentiate between patients with stroke and patients with stroke mimics. Further multicentered studies are needed to develop a "stroke screen" that reliably distinguishes pediatric stroke from its mimics.
急性脑卒中方案可改善治疗效果，但目前尚不清楚这些资源密集型方案是否能够区分儿童脑卒中与脑卒中样发作。本研究旨在描述通过我们的儿科脑卒中临床路径（PSCP）确定的脑卒中样发作。
PSCP 于 2014 年 6 月在我们的 1 级儿科急诊部门实施，适用于 1 个月至 18 岁的儿童。对于 2014 年 6 月至 2016 年 12 月期间使用 PSCP 进行管理的患者，比较了诊断为脑卒中或脑卒中样发作的患者的人口统计学和临床数据。
共有 59 名儿童接受了 PSCP 评估。14 名儿童被诊断为脑卒中，45 名儿童为脑卒中样发作。最常见的脑卒中样发作包括功能性神经障碍（20.0%）、短暂性神经功能缺损（17.8%）、偏头痛（15.6%）和癫痫发作（11.1%）。脑卒中患者和无脑卒中患者的人口统计学特征和神经影像学检查时间无差异。脑卒中患者常伴有呕吐（优势比：4.00，95%置信区间：1.12 至 14.35），而无脑卒中患者常伴有呕吐（优势比：0.7，95%置信区间：0.07 至 0.90），但脑卒中患者和无脑卒中患者的体格检查无差异。
PSCP 可确保及时评估出现神经功能缺损的患者，但无法可靠地区分脑卒中患者和脑卒中样发作患者。需要进一步开展多中心研究，以开发一种能够可靠地区分儿科脑卒中与脑卒中样发作的“脑卒中筛查”方法。
