Gladkikh Maria, McMillan Hugh J, Andrade Andrea, Boelman Cyrus, Bhathal Ishvinder, Mailo Janette, Mineyko Aleksandra, Moharir Mahendranath, Perreault Sébastien, Smith Jonathan, Pohl Daniela
University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada.
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Can J Neurol Sci. 2021 Nov;48(6):831-838. doi: 10.1017/cjn.2021.27. Epub 2021 Feb 11.
Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management.
We contacted neurologists at all 16 Canadian pediatric hospitals regarding AIS management. Established protocols were analyzed for similarities and differences in eight domains.
Response rate was 100%. Seven (44%) centers have an established AIS protocol and two (13%) have a protocol under development. Seven centers do not have a protocol; two redirect patients to adult neurology, five rely on a case-by-case approach for management. Analysis of the seven protocols revealed differences in: 1) IV-tPA dosage: age-dependent 0.75-0.9 mg/kg (N = 1) versus age-independent 0.9 mg/kg (N = 6), with maximum doses of 75 mg (N = 1) or 90 mg (N = 6); 2) IV-tPA lower age cut-off: 2 years (N = 5) versus 3 or 10 years (each N = 1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (N = 3), <5 (N = 1), <6 (N = 3); 4) first choice of pre-treatment neuroimaging: computed tomography (CT) (N = 3), magnetic resonance imaging (MRI) (N = 2) or either (N = 2); 5) intra-arterial tPA use (N = 3) and; 6) mechanical thrombectomy timeframe: <6 hour (N = 3), <24 hour (N = 2), unspecified (N = 2).
Although 44% of Canadian pediatric hospitals have established AIS management pathways, several differences remain among centers. Some criteria (dosage, imaging) reflect adult AIS literature. Canadian expert consensus regarding IV-tPA and endovascular treatment should be established to standardize and implement AIS protocols across Canada.
儿童急性动脉缺血性卒中（AIS）在症状发作后中位23小时确诊，延误了治疗。儿科卒中诊疗路径可加快诊断。我们的目标是了解加拿大儿科卒中诊疗方案的异同，以优化AIS管理。
我们联系了加拿大所有16家儿科医院的神经科医生了解AIS管理情况。对既定的诊疗方案在八个领域的异同进行分析。
回复率为100%。七个（44%）中心有既定的AIS诊疗方案，两个（13%）中心的诊疗方案正在制定中。七个中心没有诊疗方案；两个中心将患者转诊至成人神经科，五个中心采取个案管理方式。对七个诊疗方案的分析显示在以下方面存在差异：1）静脉注射组织型纤溶酶原激活剂（IV-tPA）剂量：年龄相关的0.75 - 0.9 mg/kg（N = 1）与年龄无关的0.9 mg/kg（N = 6），最大剂量分别为75 mg（N = 1）或90 mg（N = 6）；2）IV-tPA的最低年龄界限：2岁（N = 5）与3岁或10岁（各N = 1）；3）IV-tPA排除标准：儿童国立卫生研究院卒中量表（PedNIHSS）评分<4（N = 3）、<5（N = 1）、<6（N = 3）；4）治疗前首选的神经影像学检查：计算机断层扫描（CT）（N = 3）、磁共振成像（MRI）（N = 2）或两者均可（N = 2）；5）动脉内使用tPA情况（N = 3）；6）机械取栓时间范围：<6小时（N = 3）、<24小时（N = 2）、未明确规定（N = 2）。
虽然44%的加拿大儿科医院已建立AIS管理路径，但各中心之间仍存在一些差异。一些标准（剂量、影像学检查）反映了成人AIS的文献。应建立加拿大关于IV-tPA和血管内治疗的专家共识，以在加拿大标准化并实施AIS诊疗方案。
