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

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

doi:10.1161/STROKEAHA.114.004919

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

Stroke. 2014 Jul;45(7):2018-23. doi: 10.1161/STROKEAHA.114.004919. Epub 2014 Jun 10.

Authors

Timothy J Bernard¹, Michael J Rivkin¹, Kelley Scholz¹, Gabrielle deVeber¹, Adam Kirton¹, Joan Cox Gill¹, Anthony K Chan¹, Collin A Hovinga¹, Rebecca N Ichord¹, James C Grotta¹, Lori C Jordan¹, Susan Benedict¹, Neil R Friedman¹, Michael M Dowling¹, Jorina Elbers¹, Marcela Torres¹, Sally Sultan¹, Dana D Cummings¹, Eric F Grabowski¹, Hugh J McMillan¹, Lauren A Beslow¹, Catherine Amlie-Lefond²; Thrombolysis in Pediatric Stroke Study

Affiliations

¹ From the Department of Neurology, Children's Hospital Colorado, Aurora (T.J.B.); Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, MA (M.J.R.); Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.d.V.), Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada (A.K.); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, and BloodCenter of Wisconsin (J.C.G.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.K.C.); Department of Pediatrics, Dell Children's Medical Center, Austin, TX (C.A.H.), Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia (R.N.I.); Department of Neurology, Memorial Hermann Hospital, Houston, TX (J.C.G.); Division of Pediatric Neurology, Vanderbilt University, Nashville, TN (L.C.J.); Department of Neurology, Primary Children's Medical Center, Salt Lake City, UT (S.B.); Department of Neurology, Cleveland Clinic, OH (N.R.F.); Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas TX (M.M.D.); Department of Neurology, Stanford University, CA (J.E.); Department of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX (M.T.); Department of Neurology, Columbia University Medical Center, New York, NY (S.S.); Division of Child Neurology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, PA (D.D.C.); Division of Pediatric Hematology/Oncology, Department of Pediatrics, Mass General Hospital for Children, and Massachusetts General Hospital, Boston (E.F.G.); Department of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada (H.J.M.); Departments of Pediatrics and Neurology, Yale-New Haven Children's Hospital, CT (L.A.B.); Department of Neurology, Seattle Children's Hospital, WA (K.S., C.A.-L.); and Department of Neurology, University of Washington, Seattle (C.A.-L.).
² From the Department of Neurology, Children's Hospital Colorado, Aurora (T.J.B.); Departments of Neurology, Psychiatry and Radiology, Boston Children's Hospital, MA (M.J.R.); Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada (G.d.V.), Department of Neurology, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada (A.K.); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, and BloodCenter of Wisconsin (J.C.G.); Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada (A.K.C.); Department of Pediatrics, Dell Children's Medical Center, Austin, TX (C.A.H.), Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia (R.N.I.); Department of Neurology, Memorial Hermann Hospital, Houston, TX (J.C.G.); Division of Pediatric Neurology, Vanderbilt University, Nashville, TN (L.C.J.); Department of Neurology, Primary Children's Medical Center, Salt Lake City, UT (S.B.); Department of Neurology, Cleveland Clinic, OH (N.R.F.); Department of Pediatrics and Neurology, UT Southwestern Medical Center, Dallas TX (M.M.D.); Department of Neurology, Stanford University, CA (J.E.); Department of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX (M.T.); Department of Neurology, Columbia University Medical Center, New York, NY (S.S.); Division of Child Neurology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, PA (D.D.C.); Division of Pediatric Hematology/Oncology, Department of Pediatrics, Mass General Hospital for Children, and Massachusetts General Hospital, Boston (E.F.G.); Department of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada (H.J.M.); Departments of Pediatrics and Neurology, Yale-New Haven Children's Hospital, CT (L.A.B.); Department of Neurology, Seattle Children's Hospital, WA (K.S., C.A.-L.); and Department of Neurology, University of Washington, Seattle (C.A.-L.). [email protected]

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.

Keywords: child; stroke; thrombolytic therapy.

Publication types

Clinical Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

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

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

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Associated data

Grants and funding