Abstract Details

Title Beyond Stroke: Clinical Implications of a Pediatric Code Stroke Pathway at a Tertiary Care Center

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-015

Objective To review the effectiveness of a Pediatric Code Stroke (PCS) pathway in identifying patients with Serious Acute Neurologic Events (SANE).

Background The recognition and evaluation of Pediatric Stroke (PS) is complicated by frequent mimics. While this is acknowledged in multiple prior reports, there is no consensus for how to approach patients presenting with SANE.

Design/Methods A PCS pathway was implemented at our tertiary care center and we conducted a retrospective chart review of PCS activations between August 2024 and September 2025. Stroke mimics were categorized as benign (e.g. migraine, syncope, psychogenic) or serious (e.g. focal seizure, meningoencephalitis, brain tumor) based on the identification of an acute evolving process requiring intervention and the potential for persistent neurologic deficit.

Results There were 48 PCS activations with a median age of 12 years (range 3 months to 17 years) of which 58% were male. Neuroimaging was obtained in 42 patients, with 39 receiving MRI. Six activations (12.5%) identified acute cerebrovascular events, but none qualified for acute revascularization. Seventeen activations (40.5%) identified serious mimics with seizures and emesis being the most common symptoms while 25 (59.5%) identified benign mimics with headaches, language/sensory changes, and ataxia predominating. Patients diagnosed with serious mimics were more likely to have at least one stroke risk factor (65% vs 12%, p < 0.001). They were also more likely to require acute treatment and receive further diagnostic evaluation that changed management (82% vs 36%, p < 0.01).

Conclusions While few patients were identified with an acute cerebrovascular event, PCS activations identified SANE in 48% of our cohort. We propose an algorithm for the evaluation and management of patients presenting with SANE as an alternative to a PCS protocol which may be beneficial for other tertiary care centers.

Authors/Disclosures
Ritika Patel PRESENTER	Miss Patel has nothing to disclose.
John A. Pugh, MD (Albany Medical Center)	Dr. Pugh has nothing to disclose.

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