Challenges in the Diagnosis of Acute Arterial Ischemic Stroke (AIS) in Children in Saudi Arabia: Retrospective Study
Keywords:
delay, diagnosis, pediatric Arterial Ischemic StrokeAbstract
Diagnosis of arterial ischemic stroke (AIS) in children is a challenge to many clinicians. Determining the time between symptom onset and diagnosis and identifying the factors that contribute to the delay in diagnosis will help target them and provide an early and effective therapeutic strategy. A retrospective study was conducted on children diagnosed with AIS admitted to Al-Yamamah Hospital, Riyadh, Saudi Arabia from January 2000 to December 2012. Data collected included the initial symptom of AIS, time from initial symptom to hospital arrival, first medical examination; initial imaging studies, and diagnosis. A total of 51 children with AIS were studied. The median pre-hospital delay (symptom onset to hospital arrival) was 10 hours (interquartile range: 2.8-13.2 hours), in-hospital delay (symptom onset to diagnosis) was 5.5 hours (interquartile range: 2.3-20.4 hours). Younger age of the patient, lower Pediatric National Institute of Health Stroke Scale score, absence of sensory-motor deficits, absence of seizures, lack of consciousness alterations, presence of heart diseases, lower response of parents to child's condition, use of private transportation, delayed referral from private clinics, length of procedures performed in the Emergency Department (ED), and lower sensitivity of CT scans are predictors of longer time to AIS diagnosis. We have identified several pre-hospital and in-hospital predictors of delayed AIS diagnosis. Managing these factors may reduce significantly the timing of diagnosis and optimize the management of children with AIS.
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