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

Timothy J. Bernard, Michael J. Rivkin, Kelley Scholz, Gabrielle De Veber, 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. McMillanLauren A. Beslow, Catherine Amlie-Lefond

Research output: Contribution to journalArticle

61 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2018-2023
Number of pages6
JournalStroke
Volume45
Issue number7
DOIs
StatePublished - 2014

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Stroke
Pediatrics
Thrombolytic Therapy
Tissue Plasminogen Activator
Clinical Protocols
Child Care

Keywords

  • child
  • stroke
  • thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Bernard, T. J., Rivkin, M. J., Scholz, K., De Veber, G., Kirton, A., Gill, J. C., ... Amlie-Lefond, C. (2014). Emergence of the primary pediatric stroke center: Impact of the thrombolysis in pediatric stroke trial. Stroke, 45(7), 2018-2023. https://doi.org/10.1161/STROKEAHA.114.004919

Emergence of the primary pediatric stroke center : Impact of the thrombolysis in pediatric stroke trial. / Bernard, Timothy J.; Rivkin, Michael J.; Scholz, Kelley; De Veber, Gabrielle; Kirton, Adam; Gill, Joan Cox; Chan, Anthony K.; Hovinga, Collin A.; Ichord, Rebecca N.; Grotta, James C.; Jordan, Lori C.; Benedict, Susan; Friedman, Neil R.; Dowling, Michael M.; Elbers, Jorina; Torres, Marcela; Sultan, Sally; Cummings, Dana D.; Grabowski, Eric F.; McMillan, Hugh J.; Beslow, Lauren A.; Amlie-Lefond, Catherine.

In: Stroke, Vol. 45, No. 7, 2014, p. 2018-2023.

Research output: Contribution to journalArticle

Bernard, TJ, Rivkin, MJ, Scholz, K, De Veber, G, Kirton, A, Gill, JC, Chan, AK, Hovinga, CA, Ichord, RN, Grotta, JC, Jordan, LC, Benedict, S, Friedman, NR, Dowling, MM, Elbers, J, Torres, M, Sultan, S, Cummings, DD, Grabowski, EF, McMillan, HJ, Beslow, LA & Amlie-Lefond, C 2014, 'Emergence of the primary pediatric stroke center: Impact of the thrombolysis in pediatric stroke trial', Stroke, vol. 45, no. 7, pp. 2018-2023. https://doi.org/10.1161/STROKEAHA.114.004919
Bernard, Timothy J. ; Rivkin, Michael J. ; Scholz, Kelley ; De Veber, Gabrielle ; Kirton, Adam ; Gill, Joan Cox ; Chan, Anthony K. ; Hovinga, Collin A. ; Ichord, Rebecca N. ; Grotta, James C. ; Jordan, Lori C. ; Benedict, Susan ; Friedman, Neil R. ; Dowling, Michael M. ; Elbers, Jorina ; Torres, Marcela ; Sultan, Sally ; Cummings, Dana D. ; Grabowski, Eric F. ; McMillan, Hugh J. ; Beslow, Lauren A. ; Amlie-Lefond, Catherine. / Emergence of the primary pediatric stroke center : Impact of the thrombolysis in pediatric stroke trial. In: Stroke. 2014 ; Vol. 45, No. 7. pp. 2018-2023.
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AU - Bernard, Timothy J.

AU - Rivkin, Michael J.

AU - Scholz, Kelley

AU - De Veber, Gabrielle

AU - Kirton, Adam

AU - Gill, Joan Cox

AU - Chan, Anthony K.

AU - Hovinga, Collin A.

AU - Ichord, Rebecca N.

AU - Grotta, James C.

AU - Jordan, Lori C.

AU - Benedict, Susan

AU - Friedman, Neil R.

AU - Dowling, Michael M.

AU - Elbers, Jorina

AU - Torres, Marcela

AU - Sultan, Sally

AU - Cummings, Dana D.

AU - Grabowski, Eric F.

AU - McMillan, Hugh J.

AU - Beslow, Lauren A.

AU - Amlie-Lefond, Catherine

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AB - 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.

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