Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Department of Pediatrics, University of Colorado, Aurora, CO; Department of Neurology, University of Colorado, Aurora, CO.
J Pediatr. 2020 May;220:214-220.e1. doi: 10.1016/j.jpeds.2020.01.067. Epub 2020 Mar 6.
To examine the implementation and utilization of a pediatric acute stroke protocol over a 7-year period, hypothesizing improvements in protocol implementation and increased protocol use over time.
Clinical and demographic data for this retrospective observational study from 2011 through 2018 were obtained from a quality improvement database and medical records of children for whom the acute stroke protocol was activated. The initial 43 months of the protocol (period 1) were compared with the subsequent 43 months (period 2).
Over the 7-year period, a total of 385 stroke alerts were activated, in 150 children (39%) in period 1 and 235 (61%) in period 2, representing a 56% increase in protocol activation. Stroke was the final diagnosis in 80 children overall (21%), including 38 (25%) in period 1 and 42 (19%) in period 2 (P = .078). The combined frequency of diagnosed stroke, transient ischemic attack (TIA), and other neurologic emergencies remained stable across the 2 time periods at 39% and 37%, respectively (P = .745). Pediatric National Institutes of Health Stroke Scale (PedNIHSS) documentation increased from 42% in period 1 to 82% in period 2 (P < .001). Magnetic resonance imaging (MRI) was the first neuroimaging study for 68% of the children in period 1 vs 78% in period 2 (P = .038). All children with acute stroke received immediate supportive care.
Pediatric stroke protocol implementation improved over time with increased use of the PedNIHSS and use of MRI as the first imaging study. However, with increased utilization, the frequency of confirmed strokes and other neurologic emergencies remained stable. The frequency of stroke and other neurologic emergencies in these children affirms the importance of implementing and maintaining a pediatric acute stroke protocol.
考察小儿急性脑卒中方案在 7 年内的实施和利用情况，假设方案的实施情况有所改善，且随着时间的推移，方案的使用频率也会增加。
本研究为回顾性观察研究，数据来自 2011 年至 2018 年的质量改进数据库和急性脑卒中方案启动患儿的病历。将方案实施的最初 43 个月（第 1 期）与随后的 43 个月（第 2 期）进行比较。
7 年内共激活 385 次脑卒中预警，第 1 期有 150 例患儿（39%），第 2 期有 235 例（61%），方案激活率增加了 56%。380 例患儿（80%）最终诊断为脑卒中，其中第 1 期 38 例（25%），第 2 期 42 例（19%）（P=0.078）。两个时期诊断性脑卒中、短暂性脑缺血发作（TIA）和其他神经系统急症的总频率分别稳定在 39%和 37%（P=0.745）。小儿国立卫生研究院脑卒中量表（PedNIHSS）的记录从第 1 期的 42%增加到第 2 期的 82%（P<0.001）。第 1 期 68%的患儿行 MRI 检查作为首项神经影像学检查，第 2 期为 78%（P=0.038）。所有急性脑卒中患儿均接受了即刻支持性治疗。
随着 PedNIHSS 使用频率的增加以及 MRI 作为首项影像学检查的应用，小儿脑卒中方案的实施情况逐渐改善。然而，随着方案的广泛应用，确诊脑卒中及其他神经系统急症的频率保持稳定。这些患儿发生脑卒中及其他神经系统急症的频率证实了实施和维持小儿急性脑卒中方案的重要性。
