Pediatric stroke protocol
Pediatric stroke protocol created at Children's Hospital
Stroke in children is relatively uncommon compared to the adult population. Nevertheless, it is estimated a stroke occurs in one every 50,000 children each year. As a result, physicians at Children's Hospital see several potential stroke cases every year.
Children's Hospital now has the capability to save the lives of these children because of a pediatric stroke protocol activated one year ago, which involves answering key questions to quickly determine if the patient suffered a stroke, and if so, what treatment is appropriate. The type of treatment used is based on the patient's symptoms and the amount of time elapsed since the onset of those symptoms.
A stroke is caused by a blockage of blood flow, typically by a clot, to part of the brain. The major indicator of a stroke is usually sudden onset of weakness on one side of the body. To determine if a clot is present and a stroke has occurred, the radiologist must perform a computed tomography/angiography (CT-A) scan to observe the blood vessels to the brain. As a result of this protocol, any time a child comes to Children's Hospital with signs of a stroke, a CT-A scan is considered.
If the CT-A scan reveals a stroke has occurred within the past 4.5 hours and the patient is between 15 and 21 years of age, the medication rt-PA is administered. This medication, which treats strokes by dissolving clots, is now approved for patients 15 years of age and older. However, if the emergency department physician, neurologist and parents agree the child will benefit from the medication, it may sometimes be administered to pediatric stroke patients as young as 8 years of age.
Because of this time-saving protocol, rt-PA is able to be administered to patients within hours of arriving at Children's Hospital. If the patient is not a candidate for rt-PA because of age or time elapsed, this protocol allows for a radiologist to be consulted to consider other methods of removing the clot, including image-guided intervention, which is minimally invasive and done with the help of a computer and the latest technology.
Eleven Children’s Hospital physicians, on a committee led by senior pediatric neurologist Dr. Chris Miller, worked together to develop this protocol. Since its completion in fall 2010, this protocol has been activated on several occasions and has given doctors the knowledge and confidence to use treatments previously unavailable in pediatrics.
This protocol was created because pediatric strokes, while very serious, are quite treatable. Without prompt and proper treatment, up to 10 percent of pediatric stroke victims die and up to 80 percent experience long-term disabilities. While adult stroke protocols are standard, pediatric ones have been limited because of the rarity of the condition.
The protocol designed by Children's Hospital staff is being shared with other children's hospitals nationwide, so more pediatric providers will have the capability to properly diagnose, treat and save the lives of pediatric stroke patients.