Original article
Pediatric Stroke: Do Clinical Factors Predict Delays in Presentation?

https://doi.org/10.1016/j.jpeds.2008.11.011Get rights and content

Objective

To explore associations between age, clinical presentation, or predisposing conditions and delayed diagnosis of arterial ischemic stroke.

Study design

This was a retrospective chart review of children admitted to tertiary care medical centers in San Diego County between 1995 and 2000. Inpatient charts were screened by ICD-9 codes for stroke, cerebrovascular anomalies, hemiplegia, and migraine.

Results

Time of presentation for medical evaluation did not differ by age group, clinical presentation, or risk factors. There was no relationship between time of presentation and Glasgow Outcome Score. Only 24% (9/37) of the patients with ischemic stroke presented for clinical evaluation within 6 hours after onset of symptoms, and an additional 41% (13/37) presented within the first 24 hours. Children who initially presented with altered mental status were more likely to die than those with other initial presentations (odds ratio = 9.94; 95% confidence interval = 2.05 to 47.9), but none of the 16 children who presented with hemiparesis died (P = .01).

Conclusion

Time of presentation was not related to the clinical factors studied. Early recognition of stroke in children is an important goal for families and health care providers.

Section snippets

Methods

We conducted a retrospective chart review of stroke in children age 1 month to 15 years. The upper age limit was chosen to compare our epidemiologic data with previous studies of childhood stroke.8, 9 All admissions between 1995 and 2000 to any of the hospitals that provide tertiary pediatric neurologic care in San Diego County were included. The county has an Emergency Medical Services (EMS) system that provides coverage throughout the region of interest. EMS initially may have transported

General Characteristics of the Sample

The general characteristics of our study population are given in Table I and the Figure (available at www.jpeds.com). After the exclusion criteria were applied, of 859 charts available for review, 125 met all of the study criteria. Of the 89 patients with nontraumatic stroke, 57% (51/89) had ischemic stroke and 28% (25/89) had hemorrhagic stroke. The remaining patients (8/89) had mixed stroke, in which whether the major component of the stroke was due to infarct or hemorrhage was unclear or had

Discussion

Our data indicate that age, clinical presentation, underlying risk factors, inciting events, or GOS were not associated with time to presentation in the children with AIS, although this population-based study may not have been sufficiently powered to draw these conclusions. Nevertheless, children with sickle cell disease were more likely to present earlier compared with those with CHD, who were less likely to present within 24 hours. This study examined clinical factors as they relate to delay

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    Supported by Neurological Sciences Academic Development Award K12NS001696 (to A.H.). The opinions or assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Department of the Navy, Department of Defense, or the United States Government. The authors declare no conflicts of interest.

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