Standardizing Global Pediatric Stroke Pathways: Insights From a Global Survey Conducted by the Society of Neurointerventional Surgery Pediatric Special Interest Group.
Authors
Affiliations (21)
Affiliations (21)
- Neurointerventional Radiology, Clarity Brain and Spine, Cedar Park, TX (M.M.).
- Department of Neurology, University of Miami Miller School of Medicine/Jackson Health System, FL (A.R.-C.).
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.R.A.-B.).
- Departments of Radiology and Neurosurgery, University of Michigan Health System, Northville (J.J.G.).
- Pediatric Neuroendovascular Therapy, Paradise Valley, AZ (T.A.).
- Department of Radiology, Texas Children's Hospital, Houston (K.C.).
- Department of Radiology and Biomedical Imaging, University of California, San Francisco (D.L.C., S.W.H.).
- Department of Neurology and Neurosurgery, Semmes-Murphey Clinic, Memphis, TN (L.E.).
- Departments of Neurosurgery, Neurology, and Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (J.T.F.).
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN (M.T.F.).
- Department of Neurosurgery, University of Texas Medical Branch, Galveston (P.K.).
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada (P.M., C.P.-F.).
- Department of Interventional Neuroradiology, Oregon Health and Science University, Portland (G.M.N.).
- Neurointerventional Radiology (D.B.O.), Boston Children's Hospital, MA.
- Department of Neurosurgery (A.S.P.), University of Michigan, Ann Arbor.
- Department of Radiology, Children's National Hospital, Baltimore, MD (M.S.P.).
- Interventional Neuroradiology, Great Ormond Street Hospital, London, United Kingdom (A.R.).
- Department of Neurosurgery (A.P.S.), Boston Children's Hospital, MA.
- Department of Radiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL (A.S.).
- Department of Radiology (N.C.), University of Michigan, Ann Arbor.
- Department of Neurology, University of Iowa Hospitals and Clinics (S.O.-G.).
Abstract
To evaluate global stroke pathways in pediatric acute ischemic stroke care, including availability of personnel, imaging practices, hyperacute therapies available, and institutional resources. A 25-question survey designed by the Society of Neurointerventional Surgery Pediatric Special Interest Group was distributed internationally via pediatric and neurointerventional societies. The survey collected data on institutional settings, stroke team composition, imaging protocols, use of artificial intelligence, and access to thrombectomy and thrombolysis. Responses from 103 stroke care providers were analyzed using descriptive statistics. Participation was voluntary and anonymous, and >1 respondent from the same institution was permitted. Ninety-one of 103 respondents (88%) reported managing pediatric acute ischemic stroke. However, only 65% offered both intravenous thrombolysis and thrombectomy. Computed tomography and computed tomography angiography were the most commonly used first-line imaging modality (34%), whereas perfusion imaging and artificial intelligence tools were underutilized. Pediatric neurologists were the most common decision-makers for thrombolysis (38%). Posterior circulation thrombectomy was widely unavailable (offered at only 45% of centers). Survey results revealed considerable variability in pediatric acute ischemic stroke pathways globally and a lack of standardization in treatment. Disparities in access to imaging, hyperacute therapies, and trained personnel underscore the need for standardization, international collaboration, and the creation of systems utilizing available resources to improve pediatric stroke care.