Background/ Issue: Epidemiologically, pediatric strokes are rare; therefore, index of suspicion is low and many cases are not recognized early enough to qualify for acute treatment. With this small patient population, many regions have yet to develop protocols and policies for acute pediatric stroke response. In the District of Columbia, MedStar Georgetown University Hospital (MGUH) is the only Joint Commission Accredited Comprehensive Stroke Center with a pediatric intensive care unit. Purpose: The purpose of our program was to develop institutional protocols for pediatric stroke patients who are candidates for hyper-acute treatment. Protocols focused on pediatric patients who presented through our emergency department or were transferred from other facilities within the time window for acute treatment. The protocols were established to ensure a clear process for physicians and staff to follow. Methods: An interdisciplinary group met to discuss modification of our current Adult Ischemic Stroke Code Protocol needed for a coordinated approach to pediatric stroke patients. The team members included the Stroke Coordinator, Stroke Nurse Navigator, Stroke Nurse Practitioner, Pediatric Neurologist, Medical Director of the Pediatric ICU, Manager of the Pediatric ICU, Pediatric Anesthesia, Medical Director of the Stroke Program, and the Emergency Department Team. Results: The interdisciplinary team was able to adapt a protocol using the Adult Ischemic Stroke Code Protocol. Key differences between the adult and pediatric stroke code work-flow consisted of including pediatric neurologists early in the decision process, pediatric nurses to assist with monitoring children, and pediatric anesthesia for assistance with imaging and/or endovascular intervention. The order sets were adjusted to include weight- based calculations for medications, age-based monitoring parameters, and specific pediatric needs. Conclusion: It is possible to develop a Pediatric Stroke Code Protocol based on the Adult Ischemic Stroke Code Protocol to include all modifications appropriate for pediatric care and still maintain the rapid work-flow that everyone is familiar with. It is essential to include all key stakeholders to ensure a smooth and safe process.

Introduction: Recurrent strokes carry a higher risk of disability and mortality than first-ever acute ischemic stroke (AIS). Several studies have demonstrated that controlling blood pressure (BP) reduces the risk of recurrent stroke. National guidelines suggest diuretics and ACE inhibitors (ACE-i) may be preferred for BP control in stroke survivors. Hypothesis: We hypothesized that there would be a wide variation in the classes of blood pressure medications prescribed to adult AIS patients at the time of hospital discharge. Methods: We reviewed 483 consecutive adult AIS patients admitted to our institution from January 2015 to April 2017. ICH, SAH and TIA patients were excluded. BP medications were categorized by type according to the Get with the Guidelines (GWTG) database. Hypertension was defined as a known past medical history of hypertension on admission. Exploratory and descriptive analyses were performed. Results: Baseline characteristics and discharge disposition are in shown in table 1. Of the 483 AIS patients, 373 (77.2%) had a known history of hypertension. Among the patients, 335 (90%) were prescribed BP medications at discharge, 135 (40%) received an ACE-i , 69 (21%) an angiotensin receptor blocker (ARB), 121 (36%) a diuretic, 182 (54%) a beta blocker, 134 (40%) a calcium channel blocker, and 10% other BP medications. Conclusions: There is wide variation in classes of BP medications prescribed at hospital discharge after AIS. Although ACE-i and diuretics are recommended in the AHA/ASA guidelines for BP treatment after AIS, they were not prescribed to the majority of AIS patients. Further studies are needed to evaluate in-hospital antihypertensive medication prescribing patterns in a national multi-center study.