Pediatric Stroke Alert System for Quality Improvement of Stroke Recanalization (S19.003)

Objective: To investigate benefits of a pediatric stroke alert system. Background: Stroke alert systems allow rapid evaluation and time-sensitive treatment. Stroke is a leading cause of mortality and morbidity in children, and although children also benefit from early accurate diagnosis and care, few pediatric stroke alert (PSA) systems exist. With increased awareness of pediatric stroke and acute interventions, we hypothesized that PSA activations would rise over a 5-year period. Design/Methods: A centralized PSA system was initiated at St. Louis Children’s Hospital in 2013. Any healthcare provider may activate PSA for concern of stroke symptoms. A neurology resident immediately evaluates the patient, and in coordination with the stroke-alert attending decides on urgent management. PSA activations were logged in a quality improvement database from January 2013 to September 2018. Data collected included location of patient at time of alert, age, symptoms, PedNIHSS, imaging, and final diagnosis. PSA data from 2013–2015 and 2016–2018 were summarized descriptively and compared using Fisher’s exact test. Results: From 2013 to 2018, 141 stroke alerts were activated with median age 12.96 years. Acute cerebrovascular event was the final diagnosis for 36 (25%) patients, including ischemic stroke (14%), hemorrhagic stroke (2%) and TIA (9%). No child in 2013–2015, but four in 2016–2018 received recanalization therapy, including intravenous tissue-type plasminogen activator (n=1) and mechanical thrombectomy (n=3). Most PSA activations occurred from the ED (61%) and inpatient units (20%). There was an almost 3-fold increase in stroke alerts activated between 2013–2015 and 2016–2018 (36 and 105, respectively). The proportion of stroke-mimics did not significantly change over time (P-value 0.102). Besides stroke and TIA, other diagnoses included other neurologic emergencies (20%). Conclusions: Neurologic emergencies, including stroke and TIA, accounted for 43% of all PSA activations. A PSA system provides efficient care for neurologic emergencies and enables time-sensitive recanalization stroke therapy. Disclosure: Dr. Smith has nothing to disclose. Dr. Morris has nothing to disclose. Dr. Noetzel has nothing to disclose. Dr. Agner has nothing to disclose. Dr. Griffith has nothing to disclose. Dr. Guerriero has nothing to disclose. Dr. Guilliams has nothing to disclose.