Improving Timely Diagnosis of Arterial Ischemic Stroke at a Pediatric Emergency Department.

Abstract

BACKGROUND AND OBJECTIVES Pediatric arterial ischemic stroke (AIS) is an important cause of morbidity and mortality that requires early recognition to benefit from hyperacute therapies. We sought to improve timely diagnosis of AIS through an interdisciplinary stroke response protocol. METHODS A quality improvement initiative was implemented at our pediatric hospital emergency department from November 2019 to June 2023. We introduced a series of Plan-Do-Study-Act cycles that included educational initiatives (October 2021), the development of a stroke alert paging system to key stakeholders (November 2021), and stroke order set modifications (April 2022). All patients aged 0 to 21 years with clinical concern for AIS that had neuroimaging performed in the emergency department met criteria for inclusion in analysis. Our outcome measure was improvement of median door-to-imaging time for children with suspected AIS. Median door-to-imaging times for patients with confirmed stroke on imaging were also measured. Statistical process control charts were used to monitor data over time. RESULTS A total of 71 patients met criteria for inclusion in analysis during our study period. Four patients had confirmed AIS on neuroimaging. Median door-to-imaging time improved from 128 minutes to 68 minutes after intervention. Times improved from 113 minutes to 68 minutes for patients with confirmed stroke. CONCLUSION Stroke alert teams may be beneficial for coordination of care and support in ensuring a higher proportion of children with clinical concern for AIS receive expedited neuroimaging.