The University of Southampton
University of Southampton Institutional Repository

Diagnostic delays in paediatric stroke

Diagnostic delays in paediatric stroke
Diagnostic delays in paediatric stroke

BACKGROUND: Stroke is a major cause of mortality in children. Conditions that mimic stroke also cause severe morbidity and require prompt diagnosis and treatment. We have investigated the time to diagnosis in a cohort of children with stroke.

METHODS: A population-based cohort of children with stroke was prospectively identified in the south of England. Case notes, electronic hospital admission databases and radiology records were reviewed. Timing of symptom onset, presentation to hospital, first neuroimaging, first diagnostic neuroimaging and presenting clinical features were recorded.

RESULTS: Ninety-six children with an arterial ischaemic stroke (AIS) and 43 with a haemorrhagic stroke (HS) were identified. The median time from symptom onset to diagnostic neuroimaging was 24.3 h in AIS and 2.9 h in HS. The initial imaging modality was CT in 68% of cases of AIS. CT was diagnostic of AIS in 66% of cases. MRI was diagnostic in 100%. If initial neuroimaging was non-diagnostic in AIS, then median time to diagnosis was 44 h. CT was diagnostic in 95% of HS cases. Presentation outside normal working hours resulted in delayed neuroimaging in AIS (13 vs 3 h, p=0.032). Diffuse neurological signs or a Glasgow Coma Scale <9 resulted in more expeditious neuroimaging in both HS and AIS.

CONCLUSIONS: The diagnosis of AIS in children is delayed at every stage of the pathway but most profoundly when the first neuroimaging is CT scanning, which is non-diagnostic. MRI should be the initial imaging modality of choice in any suspected case of childhood AIS.

Adolescent, Child, Child, Preschool, Delayed Diagnosis, Female, Humans, Infant, Infant, Newborn, Magnetic Resonance Imaging, Male, Neuroimaging, Prospective Studies, Stroke, Time Factors, Tomography, X-Ray Computed, Journal Article, Research Support, Non-U.S. Gov't
0022-3050
917-21
Mallick, Andrew A.
97c8dd33-55de-41e8-9c2f-07f0883ef56c
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Fallon, Penny
448d79fe-cdb4-427f-aa50-492760899806
Hedderly, Tammy
05752dfa-7fae-47b0-bbfb-606185ea008b
McShane, Tony
8624e37b-473c-4803-94af-845dd3467faa
Parker, Alasdair P.
03f88b2b-62a6-42ba-b4fe-1f7279d469e0
Wassmer, Evangeline
9ce66ff0-5bbf-4f56-ad31-07501c1f3347
Wraige, Elizabeth
6dc4ee2a-a0ba-44c2-996a-5b631d4c7beb
Amin, Samir
7230de72-6a71-4e51-ad8a-3a2ff12dea96
Edwards, Hannah B.
d7cf00e7-dd66-41d5-a847-7b8a3ee5d5d6
O'Callaghan, Finbar J.
ac13f6d9-2bc3-4499-a1d9-e0911137b5fb
Mallick, Andrew A.
97c8dd33-55de-41e8-9c2f-07f0883ef56c
Ganesan, Vijeya
e3ae2ff5-0d89-43d2-8275-ba35b717149d
Kirkham, Fenella J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Fallon, Penny
448d79fe-cdb4-427f-aa50-492760899806
Hedderly, Tammy
05752dfa-7fae-47b0-bbfb-606185ea008b
McShane, Tony
8624e37b-473c-4803-94af-845dd3467faa
Parker, Alasdair P.
03f88b2b-62a6-42ba-b4fe-1f7279d469e0
Wassmer, Evangeline
9ce66ff0-5bbf-4f56-ad31-07501c1f3347
Wraige, Elizabeth
6dc4ee2a-a0ba-44c2-996a-5b631d4c7beb
Amin, Samir
7230de72-6a71-4e51-ad8a-3a2ff12dea96
Edwards, Hannah B.
d7cf00e7-dd66-41d5-a847-7b8a3ee5d5d6
O'Callaghan, Finbar J.
ac13f6d9-2bc3-4499-a1d9-e0911137b5fb

Mallick, Andrew A., Ganesan, Vijeya, Kirkham, Fenella J., Fallon, Penny, Hedderly, Tammy, McShane, Tony, Parker, Alasdair P., Wassmer, Evangeline, Wraige, Elizabeth, Amin, Samir, Edwards, Hannah B. and O'Callaghan, Finbar J. (2015) Diagnostic delays in paediatric stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 86 (8), 917-21. (doi:10.1136/jnnp-2014-309188).

Record type: Article

Abstract

BACKGROUND: Stroke is a major cause of mortality in children. Conditions that mimic stroke also cause severe morbidity and require prompt diagnosis and treatment. We have investigated the time to diagnosis in a cohort of children with stroke.

METHODS: A population-based cohort of children with stroke was prospectively identified in the south of England. Case notes, electronic hospital admission databases and radiology records were reviewed. Timing of symptom onset, presentation to hospital, first neuroimaging, first diagnostic neuroimaging and presenting clinical features were recorded.

RESULTS: Ninety-six children with an arterial ischaemic stroke (AIS) and 43 with a haemorrhagic stroke (HS) were identified. The median time from symptom onset to diagnostic neuroimaging was 24.3 h in AIS and 2.9 h in HS. The initial imaging modality was CT in 68% of cases of AIS. CT was diagnostic of AIS in 66% of cases. MRI was diagnostic in 100%. If initial neuroimaging was non-diagnostic in AIS, then median time to diagnosis was 44 h. CT was diagnostic in 95% of HS cases. Presentation outside normal working hours resulted in delayed neuroimaging in AIS (13 vs 3 h, p=0.032). Diffuse neurological signs or a Glasgow Coma Scale <9 resulted in more expeditious neuroimaging in both HS and AIS.

CONCLUSIONS: The diagnosis of AIS in children is delayed at every stage of the pathway but most profoundly when the first neuroimaging is CT scanning, which is non-diagnostic. MRI should be the initial imaging modality of choice in any suspected case of childhood AIS.

Full text not available from this repository.

More information

Accepted/In Press date: 14 September 2014
e-pub ahead of print date: 23 October 2014
Published date: August 2015
Additional Information: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Keywords: Adolescent, Child, Child, Preschool, Delayed Diagnosis, Female, Humans, Infant, Infant, Newborn, Magnetic Resonance Imaging, Male, Neuroimaging, Prospective Studies, Stroke, Time Factors, Tomography, X-Ray Computed, Journal Article, Research Support, Non-U.S. Gov't

Identifiers

Local EPrints ID: 420598
URI: https://eprints.soton.ac.uk/id/eprint/420598
ISSN: 0022-3050
PURE UUID: e4772a89-2dc7-4a59-a143-73561e1df0a7
ORCID for Fenella J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

Catalogue record

Date deposited: 10 May 2018 16:31
Last modified: 13 Jun 2019 00:37

Export record

Altmetrics

Contributors

Author: Andrew A. Mallick
Author: Vijeya Ganesan
Author: Fenella J. Kirkham ORCID iD
Author: Penny Fallon
Author: Tammy Hedderly
Author: Tony McShane
Author: Alasdair P. Parker
Author: Evangeline Wassmer
Author: Elizabeth Wraige
Author: Samir Amin
Author: Hannah B. Edwards
Author: Finbar J. O'Callaghan

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×