Acute Hospital Management of Pediatric Stroke

Surtees, Taryn-Leigh; Pearson, R. A.; Harrar, Dana; Lee, Sarah; Amlie‐Lefond, Catherine; Guilliams, Kristin P.

doi:10.1016/j.spen.2022.100990

Cited by 3 publications

(2 citation statements)

References 136 publications

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“…Early recognition of stroke symptoms and rapid neuroimaging inform time-limited medical and/or surgical interventions. Delays in diagnosis remain frequent [74][75][76] and implementation of pediatric acute stroke protocols is recommended to facilitate timely diagnosis. [76][77][78] To date, no randomized clinical trials have been completed on hyperacute recanalization therapies (thrombolysis and/or thrombectomy) in pediatric AIS, but feasibility and safety have been described.…”

Section: Pediatric Strokementioning

confidence: 99%

“…[79][80][81][82] These therapies are considered in children with radiographically confirmed AIS with large artery occlusion, with time windows extrapolated from adult data. 75,76 Children with acute stroke are often admitted to the PICU for close neuromonitoring and implementation of neuroprotective measures for at least 24 hours while undergoing a thorough evaluation to identify causative factors. For a comprehensive discussion on pediatric stroke, the reader is referred to recent reviews 75,83 and to the 2019 AHA/ASA Statement on Management of Stroke in Neonates and Children, 76 summarized in ►Table 4.…”

Section: Pediatric Strokementioning

confidence: 99%

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Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.

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Section: Pediatric Strokementioning

confidence: 99%

Section: Pediatric Strokementioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Pediatric Stroke: Recognizing the Once Imperceptible

Roach¹

2022

Seminars in Pediatric Neurology

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Clinical characteristics and quality care indicators of pediatric stroke in a referral center of Colombia: eleven-year experience (pediastroke)

Valencia-Cifuentes,

Llanos-Leyton,

Gómez-Ayala

et al. 2024

Front. Neurol.

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ObjectiveThis study aims to describe clinical variables and quality care indicators in pediatric stroke management at a high-complexity pediatric care center in Latin America.MethodsRetrospective study of patients with stroke, aged 2–18 years from 2011 to 2021. The principal outcomes were the mRs and mortality. Differences between groups were assessed using Fisher’s exact test and the Mann–Whitney U test. We used logistic regression to explore the association between characteristics reported as relevant in literature and mortality.ResultsOne hundred thirty six patients included, with a median age of 11 years, 54% were male. 47% were hemorrhagic strokes, followed by ischemic strokes at 39%. One-third of the cases presented in hospital. 51% of the patients had no prior medical history. The most common symptoms were altered consciousness, headache, and hemiparesis. The median door-to-image time was 123 min. The most frequent etiologies in ischemic stroke were arteriopathies and cardiac pathology, while vascular malformation and coagulopathies were predominant in hemorrhagic stroke. No patient received reperfusion therapy. At discharge, 48% of patients had a favorable mRs. The mortality rate was 21%. Patients with in-hospital stroke have approximately 7.37 times the odds of dying compared to those with out-of-hospital stroke. Patients with hemorrhagic stroke have approximately 7.46 times the odds of dying compared to those with ischemic stroke.ConclusionSignificant gaps exist in the epidemiology and quality indicators of pediatric stroke care compared to adult protocols. Implementing a “Pediatric code stroke” protocol and conducting prospective studies are crucial for improving pediatric stroke care and outcomes.

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Acute Hospital Management of Pediatric Stroke

Cited by 3 publications

References 136 publications

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Pediatric Stroke: Recognizing the Once Imperceptible

Clinical characteristics and quality care indicators of pediatric stroke in a referral center of Colombia: eleven-year experience (pediastroke)

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