多中心儿科卒中规范：实施后最初几年的启示

IF 2.3 3区医学 Q3 CLINICAL NEUROLOGY

European Journal of Paediatric Neurology Pub Date : 2024-10-09 DOI:10.1016/j.ejpn.2024.10.001

Ana Jové-Blanco , José Antonio Ruiz Domínguez , Aranzazu Flavia González-Posada Flores , Luisa Barón González de Suso , María de Ceano-Vivas la Calle , Cristina Verdú Sánchez , Pilar Tirado Requero , Blanca Fuentes Gimeno , Cristina Utrilla Contreras , Lidia Oviedo-Melgares , Noemí Núñez Enamorado , Ana Martínez de Aragón , Débora Sanz Álvarez , Yolanda Ruiz Martín , Antonio Carmelo Gil Nuñez , Pedro de Castro de Castro , María Vázquez-López

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引用次数: 0

摘要

背景单中心儿科急性卒中方案的制定改善了卒中的诊断和治疗。方法在马德里（西班牙）三家初级儿科卒中中心（PPSCs）的儿科急诊科（PED）进行的观察性、回顾性、病例和对照多中心研究。研究对象是在2019年3月至2022年6月期间在三家初级儿科卒中中心的任何一家儿科急诊科就诊或转诊的28天至16岁激活了PSC的儿童。主要研究结果是比较所有已激活 PSC 的患者中最终诊断为中风与中风模拟患者的特征。逻辑回归模型用于研究独立变量与中风诊断之间的关联。结果 196 名患者激活了 PSC。39名患者（19.9%）确诊为中风：20名（10.2%）为缺血性中风，19名（9.7%）为出血性中风。模拟中风的患者占 PSC 激活患者的 80.1%。偏头痛是最常见的中风模拟症状（38.3%）。从症状发作到脑部成像的时间，患者自行到 PPSC 就诊时为 233.00 分钟（IQR 153.00-373.00），而在其他场所触发 PSC 时为 231.00 分钟（IQR 129.00-400.00）（P0.580）。五名患者（25.3%）符合超急性再通治疗条件。低意识水平（OR4.373，95%IC 0.247-0.652，p <0.001）、面部/肢体感觉障碍/运动障碍（OR3.633，95%IC 0.103-0.349，p <0.001）、失语（OR2.311，95%IC 0.023-0.284，p0.022）和精神状态改变（OR2.517，95%IC 0.043-0.357，p0.013）与中风概率增加有关。结论多中心 PSC 取得了与之前报道的单中心 PSC 相似的结果，显示了这种组织的可行性。

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Multicentric Pediatric Stroke Code: Insight to the first years after implementation

Background

The development of unicentric pediatric acute stroke protocols has improved stroke diagnosis and treatment. The impact of the implementation of a multicentric Pediatric Stroke Code (PSC) remains unknown.

Aim

to describe the characteristics of the PSC activations and identify clinical features associated with stroke compared to stroke mimics in children in whom a multicentric PSC had been activated and compare them to reported monocentric PSC results.

Methods

Observational, retrospective, case and control multicentric study, performed in the Pediatric Emergency Department (PED) of the three Primary Pediatric Stroke Centers (PPSCs) in Madrid (Spain). Study population corresponded to children between 28 days and 16 years old in whom PSC was activated that consulted or were referred to any of the PPSC PED between March 2019 and June 2022. The main outcome was to compare the characteristics of patients with final diagnosis of stroke versus stroke mimics, among all patients for which PSC had been activated. Logistic regression modeling was used to investigate associations between independent variables and stroke diagnosis. Odds ratio (ORs) and 95 % confidence intervals (95%CIs) were estimated.

Results

PSC was activated in 196 patients. Stroke was confirmed in 39 patients (19.9 %): 20 (10.2 %) had an ischemic stroke and 19 (9.7 %) a hemorrhagic stroke. Stroke mimics represented 80.1 % of the PSC activations. Migraine was the most frequent stroke mimic (38.3 %). Time from symptom onset to brain imaging was 233.00 min (IQR 153.00–373.00) when patients self-presented at the PPSC compared to 231.00 min (IQR 129.00–400.00) when PSC was triggered at other settings (p0.580). Five patients (25.3 %) were eligible for hyperacute recanalization treatment. Low level of consciousness (OR4.373, 95%IC 0.247–0.652, p < 0.001), sensory disruption/motor disability of face/limbs (OR3.633, 95%IC 0.103–0.349, p < 0.001), aphasia (OR2.311, 95%IC 0.023–0.284, p0.022) and altered mental status (OR2.517, 95%IC 0.043–0.357, p0.013) were associated with an increased probability of stroke.

Conclusion

multicentric PSC achieved similar results to previously reported unicentric PSCs, showing the feasibility of such an organization.

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来源期刊

European Journal of Paediatric Neurology 医学-临床神经学

CiteScore

6.30

自引率

3.20%

发文量

115

审稿时长

81 days

期刊介绍： The European Journal of Paediatric Neurology is the Official Journal of the European Paediatric Neurology Society, successor to the long-established European Federation of Child Neurology Societies. Under the guidance of a prestigious International editorial board, this multi-disciplinary journal publishes exciting clinical and experimental research in this rapidly expanding field. High quality papers written by leading experts encompass all the major diseases including epilepsy, movement disorders, neuromuscular disorders, neurodegenerative disorders and intellectual disability. Other exciting highlights include articles on brain imaging and neonatal neurology, and the publication of regularly updated tables relating to the main groups of disorders.