Harrar Dana B, Benedetti Giulia M, Jayakar Anuj, Carpenter Jessica L, Mangum Tara K, Chung Melissa, Appavu Brian
Department of Neurology, Children's National Hospital and Departments of Neurology and Pediatrics, George Washington University School of Medicine, Washington, DC.
Department of Neurology, Seattle Children's Hospital and University of Washington, Seattle, WA.
J Pediatr. 2022 Mar;242:220-227.e7. doi: 10.1016/j.jpeds.2021.10.048. Epub 2021 Nov 11.
To describe existing pediatric acute stroke protocols to better understand how pediatric centers might implement such pathways within the context of institution-specific structures.
We administered an Internet-based survey of pediatric stroke specialists. The survey included questions about hospital demographics, child neurology and pediatric stroke demographics, acute stroke response, imaging, and hyperacute treatment.
Forty-seven surveys were analyzed. Most respondents practiced at a large, freestanding children's hospital with a moderate-sized neurology department and at least 1 neurologist with expertise in pediatric stroke. Although there was variability in how the hospitals deployed stroke protocols, particularly in regard to staffing, the majority of institutions had an acute stroke pathway, and almost all included activation of a stroke alert page. Most institutions preferred magnetic resonance imaging (MRI) over computed tomography (CT) and used abbreviated MRI protocols for acute stroke imaging. Most institutions also had either CT-based or magnetic resonance-based perfusion imaging available. At least 1 patient was treated with intravenous tissue plasminogen activator (IV-tPA) or mechanical thrombectomy at the majority of institutions during the year before our survey.
An acute stroke protocol is utilized in at least 41 pediatric centers in the US and Canada. Most acute stroke response teams are multidisciplinary, prefer abbreviated MRI over CT for diagnosis, and have experience providing IV-tPA and mechanical thrombectomy. Further studies are needed to standardize practices of pediatric acute stroke diagnosis and hyperacute management.
描述现有的儿科急性卒中治疗方案，以便更好地了解儿科中心如何在特定机构结构的背景下实施此类治疗路径。
我们对儿科卒中专家进行了一项基于互联网的调查。该调查包括有关医院人口统计学、儿童神经病学和儿科卒中人口统计学、急性卒中应对措施、影像学检查和超急性期治疗等方面的问题。
分析了47份调查问卷。大多数受访者在一家大型独立儿童医院工作，该医院有一个规模适中的神经科，且至少有1名具有儿科卒中专业知识的神经科医生。尽管各医院在部署卒中治疗方案的方式上存在差异，尤其是在人员配备方面，但大多数机构都有急性卒中治疗路径，几乎所有机构都包括启动卒中警报页面。大多数机构在急性卒中成像方面更倾向于使用磁共振成像（MRI）而非计算机断层扫描（CT），并采用简化的MRI方案。大多数机构也具备基于CT或基于磁共振的灌注成像技术。在我们调查前的一年中，大多数机构至少有1例患者接受了静脉注射组织纤溶酶原激活剂（IV-tPA）或机械取栓治疗。
美国和加拿大至少41家儿科中心采用了急性卒中治疗方案。大多数急性卒中应对团队是多学科的，在诊断时更倾向于使用简化的MRI而非CT，并且有提供IV-tPA和机械取栓治疗的经验。需要进一步开展研究以规范儿科急性卒中诊断和超急性期管理的做法。
