Topical Review| Volume 56, P18-24, March 2016

Preparing for a “Pediatric Stroke Alert”



      Childhood arterial ischemic stroke is an important cause of morbidity and mortality in children. Hyperacute treatment strategies remain controversial and challenging, especially in the setting of increasingly proven medical and endovascular options in adults. Although national and international pediatric guidelines have given initial direction about acute therapy and management, pediatric centers have traditionally lacked the infrastructure to triage, diagnose, and treat childhood arterial ischemic stroke quickly.


      In the past 10 years, researchers in the International Pediatric Stroke Study and Thrombolysis in Pediatric Stroke study have initiated early strategies for establishing pediatric specific stroke alerts.


      We review the rationale, process and components necessary for establishing a pediatric stroke alert.


      Development of pediatric stroke protocols and pathways, with evidence-based acute management strategies and supportive care where possible, facilitates the evaluation, management, and treatment of an acute pediatric stroke.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fullerton H.J.
        • Wu Y.W.
        • Zhao S.
        • Johnston S.C.
        Risk of stroke in children: ethnic and gender disparities.
        Neurology. 2003; 61: 189-194
        • Roach E.S.
        • Golomb M.R.
        • Adams R.
        • et al.
        Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young.
        Stroke. 2008; 39: 2644-2691
        • Monagle P.
        • Chan A.K.
        • Goldenberg N.A.
        • et al.
        Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e737S-e801S
        • Bernard T.J.
        • Rivkin M.J.
        • Scholz K.
        • et al.
        Emergence of the primary pediatric stroke center: impact of the Thrombolysis in Pediatric Stroke Trial.
        Stroke. 2014; 45: 2018-2023
        • DeVeber G.
        The International Paediatric Stroke Study.
        2010 (Available at:) (Accessed January 15, 2016)
        • Janjua N.
        • Nasar A.
        • Lynch J.K.
        • Qureshi A.I.
        Thrombolysis for ischemic stroke in children: data from the nationwide inpatient sample.
        Stroke. 2007; 38: 1850-1854
        • Amlie-Lefond C.
        • DeVeber G.
        • Chan A.K.
        • et al.
        Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study.
        Lancet Neurol. 2009; 8: 530-536
        • Golomb M.R.
        • Rafay M.
        • Armstrong D.
        • et al.
        Intra-arterial tissue plasminogen activator for thrombosis complicating cerebral angiography in a 17-year-old girl.
        J Child Neurol. 2003; 18: 420-423
        • Rhee E.
        • Hurst R.
        • Pukenas B.
        • et al.
        Mechanical embolectomy for ischemic stroke in a pediatric ventricular assist device patient.
        Pediatr Transplant. 2014; 18: E88-E92
        • Kirton A.
        • Wong J.H.
        • Mah J.
        • et al.
        Successful endovascular therapy for acute basilar thrombosis in an adolescent.
        Pediatrics. 2003; 112: e248-e251
        • Campbell B.C.
        • Mitchell P.J.
        • Kleinig T.J.
        • et al.
        Endovascular therapy for ischemic stroke with perfusion-imaging selection.
        N Engl J Med. 2015; 372: 1009-1018
        • Goyal M.
        • Demchuk A.M.
        • Menon B.K.
        • et al.
        Randomized assessment of rapid endovascular treatment of ischemic stroke.
        N Engl J Med. 2015; 372: 1019-1030
        • Saver J.L.
        • Goyal M.
        • Bonafe A.
        • et al.
        Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.
        N Engl J Med. 2015; 372: 2285-2295
        • Jovin T.G.
        • Chamorro A.
        • Cobo E.
        • et al.
        Thrombectomy within 8 hours after symptom onset in ischemic stroke.
        N Engl J Med. 2015; 372: 2296-2306
        • Govan L.
        • Langhorne P.
        • Weir C.J.
        Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?: further analysis of a systematic review.
        Stroke. 2007; 38: 2536-2540
        • Amlie-Lefond C.
        • Chan A.K.
        • Kirton A.
        • et al.
        Thrombolysis in acute childhood stroke: design and challenges of the Thrombolysis in Pediatric Stroke clinical trial.
        Neuroepidemiology. 2009; 32: 279-286
        • Rivkin M.J.
        • DeVeber G.
        • Ichord R.N.
        • et al.
        Thrombolysis in Pediatric Stroke study.
        Stroke. 2015; 46: 880-885
        • Bernard T.J.
        • Goldenberg N.A.
        • Armstrong-Wells J.
        • Amlie-Lefond C.
        • Fullerton H.J.
        Treatment of childhood arterial ischemic stroke.
        Ann Neurol. 2008; 63: 679-696
        • Srinivasan J.
        • Miller S.P.
        • Phan T.G.
        • Mackay M.T.
        Delayed recognition of initial stroke in children: need for increased awareness.
        Pediatrics. 2009; 124: e227-e234
        • Shellhaas R.A.
        • Smith S.E.
        • O'Tool E.
        • Licht D.J.
        • Ichord R.N.
        Mimics of childhood stroke: characteristics of a prospective cohort.
        Pediatrics. 2006; 118: 704-709
        • Bhatt A.
        • Safdar A.
        • Chaudhari D.
        • et al.
        Medicolegal considerations with intravenous tissue plasminogen activator in stroke: a systematic review.
        Stroke Res Treat. 2013; 2013: 562564
        • Jauch E.C.
        • Saver J.L.
        • Adams Jr., H.P.
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 870-947
        • Powers W.J.
        • Derdeyn C.P.
        • Biller J.
        • et al.
        2015 AHA/ASA focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2015; 46: 3020-3035
        • Yock-Corrales A.
        • Babl F.E.
        • Mosley I.T.
        • Mackay M.T.
        Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke?.
        BMC Pediatr. 2011; 11: 93
        • Ichord R.N.
        • Bastian R.
        • Abraham L.
        • et al.
        Interrater reliability of the Pediatric National Institutes of Health Stroke Scale (PedNIHSS) in a multicenter study.
        Stroke. 2011; 42: 613-617
        • Wintermark M.
        • Sanelli P.C.
        • Albers G.W.
        • et al.
        Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery.
        J Am Coll Radiol. 2013; 10: 828-832
        • Mackay M.T.
        • Chua Z.K.
        • Lee M.
        • et al.
        Stroke and nonstroke brain attacks in children.
        Neurology. 2014; 82: 1434-1440