Objective:

To review the incidence, clinical risk factors and imaging trends for pediatric stroke following implementation of a pediatric stroke protocol at a major children's hospital.

Background:

As the incidence of pediatric stroke continues to rise, the need for dedicated pediatric stroke protocols and continued surveillance of pediatric stroke metrics is imperative for improving stroke care in this population.

Design/Methods:

Retrospective chart review was completed on 184 pediatric stroke codes called between February 2020 and September 2024. Multiple metrics including patient demographic data, past medical history, time from last known well to stroke code as well as imaging data was collected and analyzed.

Results:

There was a total of 184 stroke codes called between 2020-2024. The ICU called the majority of stroke codes (39%), followed by the ED (33%). The most common presenting symptom for which a stroke code was called was focal weakness (48%). Of the 184 stroke codes called, 59 patients (32%) had confirmed stroke on imaging. Of those that had stroke, 41 were ischemic stroke (69%) while 18 were hemorrhagic (31%). Of patients with confirmed stroke on imaging, 50% of those patients had known cardiac disease. In terms of initial imaging modalities, CT was the initial image in 113 stroke codes while MRI was the initial image in 35.  

Conclusions:

Implementation of a pediatric stroke code protocol at our institution has led to a systematic approach for early diagnosis and management of pediatric strokes as well as highlighting the need for a separate approach for critically ill cardiac patients. Underlying cardiac disease is a major risk factor for stroke. This study also indicates the higher incidence of stroke mimickers in the pediatric population, supporting MRI as initial imaging modality over CT.