Hori Ikumi, Tsuji Takeshi, Miyake Misa, Ueda Kazuto, Kataoka Erina, Suzuki Michio, Kobayashi Satoru, Kurahashi Hirokazu, Takahashi Yoshiyuki, Okumura Akihisa, Yoshikawa Tetsushi, Saitoh Shinji, Natsume Jun
Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Pediatric Stroke Study Group in Aichi Prefecture, Nagoya, Aichi, Japan.
Pediatr Int. 2019 Sep;61(9):895-903. doi: 10.1111/ped.13966.
Few population-based surveys of childhood arterial ischemic stroke (AIS) have been conducted in Asian countries. The aim of this study was to investigate the clinical features, time to diagnosis, and prognosis of childhood AIS in a population-based cohort in Japan.
Children aged 29 days-15 years 11 months old, residing in the Aichi Prefecture of Japan with radiologically confirmed AIS during 2010-2014, were identified retrospectively through questionnaires. We analyzed 40 children (23 boys, 17 girls; median age, 7 years 3 months), and collected time interval information of 26 patients. The time from clinical onset to first physician assessment and the time to AIS diagnosis were calculated.
The most common presentation was paralysis or paresis in 27 patients (71%). No underlying disorders or possible trigger factors were identified in 14 patients (35%). The median time from symptom onset to first physician assessment was 2.9 h. The median time from symptom onset to the confirmed AIS diagnosis was 27.0 h. The diagnosis of AIS was made in the first 6 h after onset of symptoms in 27% of patients for whom the time was available. Radiological diagnosis took longer than 24 h in 54% of these patients.
Long in-hospital delays exist in the diagnosis of AIS in children, likely due to lack of awareness of stroke by doctors. Further efforts to increase public and physician awareness of childhood stroke are needed to ensure early diagnosis and treatment.
亚洲国家很少开展基于人群的儿童动脉缺血性卒中（AIS）调查。本研究旨在调查日本一个基于人群的队列中儿童AIS的临床特征、诊断时间和预后。
通过问卷调查回顾性确定2010年至2014年期间居住在日本爱知县、年龄在29天至15岁11个月且经放射学确诊为AIS的儿童。我们分析了40名儿童（23名男孩，17名女孩；中位年龄7岁3个月），并收集了26名患者的时间间隔信息。计算从临床发病到首次医生评估的时间以及AIS诊断时间。
最常见的表现是27例患者（71%）出现瘫痪或轻瘫。14例患者（35%）未发现潜在疾病或可能的触发因素。从症状发作到首次医生评估的中位时间为2.9小时。从症状发作到确诊AIS诊断的中位时间为27.0小时。在有时间信息的患者中，27%在症状发作后的前6小时内确诊为AIS。这些患者中有54%的放射学诊断时间超过24小时。
儿童AIS的诊断存在较长的院内延迟，可能是由于医生对卒中缺乏认识。需要进一步努力提高公众和医生对儿童卒中的认识，以确保早期诊断和治疗。
