Emergency Department Clinical Pathway for Stroke Management

Goals and Metrics
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, VS, Neurologic Exam
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
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: October 2011, October 2017, October 2019 (Reviewed)
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;