Use of a Stroke Alert Protocol and Outcomes at a Quaternary Children’s Hospital

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2024-10-18 DOI:10.1016/j.jpeds.2024.114364

Benjamin Africk MD , Ingrid Luo MS , Andrew Silverman MD, MHS , Prathyusha Teeyagura MSBI , Karla Jackson MSN , Jeilo Gauna BA , Elizabeth Mayne MD, PhD , Sarah Lee MD

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引用次数: 0

Abstract

Objective

To assess for improvement in diagnostic efficiency following implementation of an institutional pediatric stroke alert protocol at a quaternary children's hospital, and to compare characteristics of in-hospital (IH) and out-of-hospital (OH) stroke alert activations.

Study design

We retrospectively reviewed data from pediatric stroke alerts called for children between age 1 month and 21 years of age at our quaternary children's hospital between October 2016 and October 2022 after implementation of an institutional stroke alert protocol. Generalized linear models assessed code-to-image (CTI) time over the study period, with and without interaction terms for alert location. Demographic, clinical, and imaging characteristics between IH and OH alerts were compared using Fisher's exact test or Mann–Whitney U test.

Results

Of 206 total stroke activations, 129 (62.6%) occurred IH and 77 (37.4%) occurred OH. Overall mean CTI time decreased by 4.56 minutes per year (P = .007) after adjusting for confounders. The association between year and mean CTI time was significantly stronger for IH alerts (decrease of 8.33 minutes/year) compared with OH alerts (increase of 1.90 minutes/year). Subgroup analyses showed that CTI for computed tomography (CT) ± CT angiography and magnetic resonance imaging (MRI) without sedation improved, although CTI time for MRI with sedation did not change over time. IH/OH divergent trends were consistent for CT ± CTA and nonsedated MRI.

Conclusions

After implementation of a pediatric stroke alert protocol, we observed a steady and significant improvement in CTI times for IH, but not OH alerts.

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一家四级儿童医院的脑卒中警报协议的使用和结果。

目的目的：评估一家四级儿童医院在实施儿科卒中机构警报协议后诊断效率的改善情况，并比较院内（IH）和院外（OH）卒中警报启动的特征：研究设计：我们回顾性审查了本市一家四级儿童医院在实施机构卒中警报协议后于 2016 年 10 月至 2022 年 10 月期间为 1 个月至 21 岁儿童发出的儿科卒中警报数据。广义线性模型评估了研究期间从代码到图像（CTI）的时间，包括警报地点的交互项和不包括警报地点的交互项。使用费舍尔精确检验或曼-惠特尼 U 检验比较了 IH 和 OH 警报之间的人口统计学、临床和影像学特征：结果：在 206 次卒中激活中，129 次（62.6%）发生在 IH，77 次（37.4%）发生在 OH。调整混杂因素后，总体平均 CTI 时间每年减少 4.56 分钟（p = 0.007）。与 OH 警报（每年增加 1.90 分钟）相比，IH 警报（每年减少 8.33 分钟）与平均 CTI 时间之间的关联明显更强。亚组分析表明，计算机断层扫描（CT）± CT 血管造影和无镇静剂磁共振成像（MRI）的 CTI 有所改善，但有镇静剂磁共振成像的 CTI 时间没有随时间变化。CT ± CTA 和无镇静 MRI 的 IH/OH 变化趋势一致：结论：实施儿科卒中预警方案后，我们观察到 IH 的 CTI 时间有了稳定而显著的改善，但 OH 的 CTI 时间没有改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.