Mark N. Rubin, MD

Ladner T, Mahdi J, Gindville M, Gordon A, Harris ZH, Crossman K, et al. Pediatric Acute Stroke Protocol Activation in a Children’s Hospital Emergency Department. Stroke. 2015
Systems of care in stroke have saved lives and improved care. It is broadly accepted that a solid multidisciplinary stroke system of care is more important than any individual provider. There is certainly no “I” in stroke. 

Pediatric stroke is (thankfully) a rare bird, but at large centers serving 2 million people with 50,000 pediatric-specific emergency department visits annually, it comes up every now and again. Vanderbilt clinician researchers published their experience with developing and implementing a multidisciplinary stroke alert system for kids akin to what we know of for adults.

They prospectively tracked patient data over the 3.5 year period published (4/2011-10/2014). They had 124 first-time stroke alerts, of which 30 were strokes, 2 TIA, and 17 non-stroke neurologic emergencies. Of note, 46 were healthy without any known medical problems and only 4 stroke patients had known sickle cell anemia or congenital heart disease. They tracked various chronologic data, akin to “conventional” adult stroke alerts, and described their protocol for urgent MRI which was the preferred and most often initial neuroimaging study.

These data are novel and important, if for no other reason than to promote the development of multidisciplinary care teams for neurologic emergencies in kids. At this center (with arguably unique expertise given their size and volume), 25% of alerts were actual acute neurovascular episodes and 40% neurologic emergencies (including those strokes), many of which have time-sensitive evaluation and treatment plans as does stroke. While pediatric stroke does not have nearly the same incidence as in the adult world, where systems of stroke care are of critical importance to individual patients and us as a society, a system like that which is described here is a solid practice improvement and is reasonable to explore for a center with high pediatric medical acuity.