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Abstract Details

Pediatric Stroke Protocols in Canada
Child Neurology and Developmental Neurology
P12 - Poster Session 12 (12:00 PM-1:00 PM)
5-014
To understand the management of childhood acute ischemic stroke (AIS) and review AIS protocols across Canadian pediatric hospitals.
An estimated 1,000 children present with AIS annually in North America, and most suffer from long-term neurological disability. Childhood AIS is diagnosed after a median of 23 hours post symptom onset. This delay limits thrombolytic treatment options that have the potential to improve outcomes. Pediatric stroke protocols have been shown to decrease time to diagnosis. The treatment of AIS is not uniform across pediatric hospitals, nor are pediatric stroke protocols standardized across institutions.
We contacted neurologists at all 16 Canadian pediatric hospitals regarding their AIS management. 
Response rate was 100%. Seven (44%) centers have a formal AIS protocol and 2 (13%) have a protocol under development. Seven centers do not have a protocol. Of the latter, 2 centers redirect patients to adult neurology, and 5 rely on a case-by-case approach to manage AIS. Analysis of the 7 established AIS protocols reveals differences: 1) IV-tPA dosage: age-dependent 0.75-0.9 mg/kg (1 site) versus age-independent 0.9 mg/kg (6 sites), with maximum doses of 60 mg (3 sites), 75 mg (1 site) or 90 mg (3 sites); 2) Lower age cut-off for IV-tPA: 2 years (4 sites) versus 3, 4 or 10 years (each 1 site); 3) Exclusion criteria for tPA: PedNIHSS score <4 (3 sites), <5 (1 site), or <6 (3 sites); 4) Choice of preferred pre-treatment neuroimaging: CT (3 sites) versus MRI (4 sites); and 5) Use of intra-arterial tPA (available at 3 sites).

The 7 Canadian pediatric AIS protocols show differences including maximum tPA dose and key inclusion / exclusion criteria. Structured interviews are underway to explore reasons for variations. Our overarching goal is to improve the management of children with AIS, with a view to reducing long-term morbidity.

Authors/Disclosures

PRESENTER 		No disclosure on file
Hugh J. McMillan, MD (Children's Hospital of Eastern Ontario) Dr. McMillan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis Gene Therapies. Dr. McMillan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis Gene Therapies. The institution of Dr. McMillan has received research support from Roche.
Andrea Andrade, MD No disclosure on file
No disclosure on file
Cyrus Boelman, MD (BC Children'S Hospital) No disclosure on file
Janette A. Mailo, MD (Children'S Hospital of Western Ontario) No disclosure on file
Aleksandra Mineyko, MD Dr. Mineyko has nothing to disclose.
No disclosure on file
Sebastien Perreault, MD (CHU Sainte-Justine) Dr. Perreault has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Perreault has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Perreault has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer. The institution of Dr. Perreault has received research support from Novartis. The institution of Dr. Perreault has received research support from Rocher.
Jonathan Smith, MD No disclosure on file
Daniela Pohl Daniela Pohl has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Syneos.