The Journal of Pediatrics
Volume 154, Issue 5 , Pages 727-732.e1, May 2009

Pediatric Stroke: Do Clinical Factors Predict Delays in Presentation?

  • Adam L. Hartman, MD

      Affiliations

    • Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD
    • Corresponding Author InformationReprint requests: Adam L. Hartman, MD, Johns Hopkins Hospital, Department of Neurology, 600 N Wolfe Street, Meyer 2-147, Baltimore, MD 21287
    • ,
  • Kevin M. Lunney, PhD

      Affiliations

    • Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD
    • ,
  • Jacqueline E. Serena, MD

      Affiliations

    • Department of Pediatrics, Naval Medical Center San Diego, San Diego, CA

Received 5 June 2008; received in revised form 29 September 2008; accepted 5 November 2008. published online 29 December 2008.

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.

Abbreviations: AIS, Acute ischemic stroke, CHD, Congenital heart disease, EMS, Emergency Medical Services, GOS, Glasgow Outcome Score, ICD, International Classification of Diseases

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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.

PII: S0022-3476(08)00978-5

doi:10.1016/j.jpeds.2008.11.011

The Journal of Pediatrics
Volume 154, Issue 5 , Pages 727-732.e1, May 2009

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