Suspected Stroke Clinical Pathway — Emergency Department

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Child with Suspected Stroke

Transfer from Outside Hospital

Transport RN:
- Triage symptoms for possible stroke
- Call Stroke Pager & link referring
- MD to Stroke Service Provider while on transport line
- Connect stroke service responder to either ED-MCP or PICU admit fellow to coordinate care
If concern for stroke:
- Ensure outside hospital has uploaded images
- Direct stroke consultant to contact Neuroradiology
Stroke Team (xTend): 75842

Triage

Stroke Screening Questions
History and Physical
Risk Factors for Pediatric Stroke
Signs/Symptoms of Childhood Stroke Syndrome
Page Stroke Team (xTend): 75842

High Concern

Low Concern

Further care, Neurology consult as clinically indicated

Persistent
Neurologic Symptoms/Deficits

Obtain imaging per discussion with Stroke Team with CT or MRI

Imaging per ED/Neurology Discussion

Continue neuroprotective intervention
Discuss further care with Stroke Team
- Antithrombosis
- Anticonvulsants
- Special cases
Initial Treatment Guidelines

Normal CT or MRI
Reassess symptoms
Discuss disposition with Stroke Team

Admit ICU

Admit to Neurology/ICU or
discharge to home

Stroke Screening Questions
Is there a focal neurologic deficit?
- Unilateral weakness or sensory change
- Vision loss, double vision
- Speech difficulty
- Dizziness or trouble walking
- New onset seizures with focal findings
Did the problem begin or get worse suddenly?
- What was the time of symptom onset?
- When was child last seen symptom free?
When did the child last eat or drink?
Does the child have dental hardware?

Risk Factors for Pediatric Stroke

Signs/Symptoms of Childhood Stroke Syndrome

Posted: September 2007
Revised: February 2022
Authors: R. Ichord; MD, J. Lavelle, MD; R. Rempell, MD; N. Tsarouhas, MD; C. Jacobstein, MD; MK Abbadessa, RN; J. Baren, MD; L. Fahringer, RN;

Evidence

CHOP Program

Pediatric Stroke Program

Educational Media

Evaluating Stroke in Children Video

Related Links

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.