Use of a Stroke Alert Protocol and Outcomes at a Quaternary Children’s Hospital

To assess for improvement in diagnostic efficiency following implementation of an institutional pediatric stroke alert protocol at a quaternary children's hospital, and to compare characteristics of in-hospital (IH) and out-of-hospital (OH) stroke alert activations. We retrospectively reviewed data from pediatric stroke alerts called for children between age 1 month and 21 years of age at our quaternary children's hospital between October 2016 and October 2022 after implementation of an institutional stroke alert protocol. Generalized linear models assessed code-to-image (CTI) time over the study period, with and without interaction terms for alert location. Demographic, clinical, and imaging characteristics between IH and OH alerts were compared using Fisher's exact test or Mann–Whitney U test. Of 206 total stroke activations, 129 (62.6%) occurred IH and 77 (37.4%) occurred OH. Overall mean CTI time decreased by 4.56 minutes per year (P = .007) after adjusting for confounders. The association between year and mean CTI time was significantly stronger for IH alerts (decrease of 8.33 minutes/year) compared with OH alerts (increase of 1.90 minutes/year). Subgroup analyses showed that CTI for computed tomography (CT) ± CT angiography and magnetic resonance imaging (MRI) without sedation improved, although CTI time for MRI with sedation did not change over time. IH/OH divergent trends were consistent for CT ± CTA and nonsedated MRI. After implementation of a pediatric stroke alert protocol, we observed a steady and significant improvement in CTI times for IH, but not OH alerts.