Time is brain in children too

The diagnosis of stroke in children is often delayed because of a lack of awareness among medical professionals, even among high-risk children, a study finds. The 12-year study of over 100 neonates and children with radiologically confirmed arterial ischaemic stroke (AIS) found the median time to diagnosis was nearly 88 hours for neonates and 25 hours for children. This was despite the fact that more than half (58%) of the children were inpatients at the time of their strokes and almost 69% had known cardiac risk factors. Although 86% of the children had focal signs of stroke the authors from the Royal Children’s Hospital in Melbourne found that while its presence was not associated with a shorter diagnosis time it did increase suspicion of stroke (p=0.02). There was significantly less documentation of AIS suspicion in the medical records of neonates than children (p=0.04), and seizures were more common at presentation for neonates than children. “Stroke should be suspected for any neonate presenting with seizures, lethargy, or apnea, the latter 2 features being seen in neonatal stroke in the setting of encephalopathy,” wrote lead author Dr Jayasri Srinivasan in Pediatrics. “Clearly, there are delays in childhood stroke diagnosis that must be addressed with increased awareness among medical professionals, particularly for high-risk groups such as children with cardiac disease,” they said. Ideally, they concluded, development of hospital based paediatric stroke services will improve early diagnosis of stroke, to allow children the benefits of acute medical interventions that have been shown to improve outcomes in the adult population. Pediatrics 2009; published online before print  ...