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Abstract Details

Pediatric Stroke Alert System for Quality Improvement of Stroke Recanalization
Child Neurology and Developmental Neurology
S19 - Child Neurology: Updates in Autism, Migraine, MS, and Stroke (3:52 PM-4:03 PM)
003
Stroke alert systems allow rapid evaluation and time-sensitive treatment. Stroke is a leading cause of mortality and morbidity in children, and although children also benefit from early accurate diagnosis and care, few pediatric stroke alert (PSA) systems exist.  With increased awareness of pediatric stroke and acute interventions, we hypothesized that PSA activations would rise over a 5-year period.
To investigate benefits of a pediatric stroke alert system.

A centralized PSA system was initiated at St. Louis Children’s Hospital in 2013. Any healthcare provider may activate PSA for concern of stroke symptoms.  A neurology resident immediately evaluates the patient, and in coordination with the stroke-alert attending decides on urgent management. PSA activations were logged in a quality improvement database from January 2013 to September 2018. Data collected included location of patient at time of alert, age, symptoms, PedNIHSS, imaging, and final diagnosis. PSA data from 2013-2015 and 2016-2018 were summarized descriptively and compared using Fisher’s exact test. 
From 2013 to 2018, 141 stroke alerts were activated with median age 12.96 years. Acute cerebrovascular event was the final diagnosis for 36 (25%) patients, including ischemic stroke (14%), hemorrhagic stroke (2%) and TIA (9%). No child in 2013-2015, but four in 2016-2018 received recanalization therapy, including intravenous tissue-type plasminogen activator (n=1) and mechanical thrombectomy (n=3). Most PSA activations occurred from the ED (61%) and inpatient units (20%). There was an almost 3-fold increase in stroke alerts activated between 2013-2015 and 2016-2018 (36 and 105, respectively). The proportion of stroke-mimics did not significantly change over time (P-value 0.102). Besides stroke and TIA, other diagnoses included other neurologic emergencies (20%).

Neurologic emergencies, including stroke and TIA, accounted for 43% of all PSA activations. A PSA system provides efficient care for neurologic emergencies and enables time-sensitive recanalization stroke therapy.
Authors/Disclosures
Alyssa Smith, MD (Pediatric Neurology, Washington University in St. Louis)
PRESENTER 		No disclosure on file
Stephanie Morris, MD (Washington University) No disclosure on file
Michael J. Noetzel, MD (Dept of Pediatric Neurology) No disclosure on file
Shannon Agner, MD (Washington University in St. Louis, Child Neurology) No disclosure on file
Jennifer L. Griffith, MD (Washington University in St. Louis, Child Neurology) No disclosure on file
Rejean M. Guerriero, MD (St. Louis Children'S Hospital) No disclosure on file
Kristin Guilliams, MD (WASHINGTON UNIVERSITY IN ST LOUIS) Dr. Guilliams has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Wiseman Ashworth Law Group. The institution of Dr. Guilliams has received research support from NIH.