Emergence of the primary pediatric stroke center: impact of the thrombolysis in pediatric stroke trial.

Abstract

BACKGROUND AND PURPOSE:

In adult stroke, the advent of thrombolytic therapy led to the development of primary stroke centers capable to diagnose and treat patients with acute stroke rapidly. We describe the development of primary pediatric stroke centers through preparation of participating centers in the Thrombolysis in Pediatric Stroke (TIPS) trial.

METHODS:

We collected data from the 17 enrolling TIPS centers regarding the process of becoming an acute pediatric stroke center with capability to diagnose, evaluate, and treat pediatric stroke rapidly, including use of thrombolytic therapy.

RESULTS:

Before 2004, <25% of TIPS sites had continuous 24-hour availability of acute stroke teams, MRI capability, or stroke order sets, despite significant pediatric stroke expertise. After TIPS preparation, >80% of sites now have these systems in place, and all sites reported increased readiness to treat a child with acute stroke. Use of a 1- to 10-Likert scale on which 10 represented complete readiness, median center readiness increased from 6.2 before site preparation to 8.7 at the time of site activation (P≤0.001).

CONCLUSIONS:

Before preparing for TIPS, centers interested in pediatric stroke had not developed systematic strategies to diagnose and treat acute pediatric stroke. TIPS trial preparation has resulted in establishment of pediatric acute stroke centers with clinical and system preparedness for evaluation and care of children with acute stroke, including use of a standardized protocol for evaluation and treatment of acute arterial stroke in children that includes use of intravenous tissue-type plasminogen activator.

CLINICAL TRIAL REGISTRATION URL:

http://www.clinicaltrials.gov. Unique identifier: NCT01591096.

• Authors: Timothy J Bernard, Michael J Rivkin, Kelley Scholz, Gabrielle deVeber, Adam Kirton, Joan Cox Gill, Anthony K Chan, Collin A Hovinga, Rebecca N Ichord, James C Grotta, Lori C Jordan, Susan Benedict, Neil R Friedman, Michael M Dowling, Jorina Elbers, Marcela Torres, Sally Sultan, Dana D Cummings, Eric F Grabowski, Hugh J McMillan, Lauren A Beslow, Catherine Amlie-Lefond, Thrombolysis in Pediatric Stroke Study
• Journal: Stroke (Stroke) Vol. 45 Issue 7 Pg. 2018-23 (Jul 2014) ISSN: 1524-4628 [Electronic] United States
• PMID: 24916908 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Heart Association, Inc.

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Adolescent
• Child
• Child, Preschool
• Clinical Trials as Topic (standards)
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Hospitals, Pediatric (organization & administration, standards, statistics & numerical data)
• Humans
• Male
• Multicenter Studies as Topic
• Quality of Health Care (standards, statistics & numerical data)
• Stroke (drug therapy, therapy)
• Tertiary Care Centers (organization & administration, standards, statistics & numerical data)
• Thrombolytic Therapy (adverse effects, methods, standards)
• Tissue Plasminogen Activator (administration & dosage, adverse effects)