{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:14:50Z","timestamp":1788484490722,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2016,9,6]],"date-time":"2016-09-06T00:00:00Z","timestamp":1473120000000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In\u2010hospital factors contribute more to delayed diagnosis of childhood arterial ischemic stroke (<jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>) than prehospital factors. We aimed to explore process and patient factors associated with type of and timing to neuroimaging in childhood <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> in the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective hospital registry\u2013based study of children with <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content>, presenting to an Australian tertiary pediatric <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> between January 2003 and December 2012. Neuroimaging data and timelines of care were also collected from referring hospitals for transferred patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010one <jats:styled-content style=\"fixed-case\">AIS<\/jats:styled-content> episodes and 19 transient ischemic attacks were recorded. The majority (56%) were initially seen at a referring hospital. Patients underwent computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) as first scan more frequently than magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) as first scan (61% vs. 32%) at both the referring and the tertiary hospitals. Time to first scan as <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> was significantly shorter compared with <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> (median<jats:italic> =<\/jats:italic> 1.5 hours vs. 10.9 hours, p &lt; 0.001). <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> was performed more often at the tertiary hospital (92.5% vs. 26%, p = 0.001). Median time to performance of diagnostic <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> was 15.1 hours (interquartile range = 7.1\u201323.5), with no significant difference between patients first presenting to a referring hospital and those directly accessing the tertiary center. Patient characteristics including age, past medical history, conscious state, focal symptoms, and signs on arrival were not associated with the type of first neuroimaging or time to diagnostic <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>. Patients presenting during weekends were less likely to receive an <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> as first scan (odds ratio [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>] = 0.3, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] = 0.1\u20130.8), while time to <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> was significantly longer for children presenting after hours (5 <jats:sc>pm<\/jats:sc>\u20138 <jats:sc>am<\/jats:sc>; median<jats:italic> =<\/jats:italic> 17.6 hours vs. 8.4 hours, p = 0.026). <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> overall and as first scan was associated with a higher use of sedation than <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> = 6.5, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 1.3\u201332.9; and <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> = 3.9, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 1.3\u201311.8), particularly for children younger than 5 years of age (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> = 12.5, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> = 3\u201352.4).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies and where possible rapid transfer to the tertiary center. Future priorities should include development of pediatric <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> physician decision support tools to differentiate stroke from mimics and the development and implementation of rapid <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> imaging stroke protocols to improve access to confirmatory <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> scanning.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13001","type":"journal-article","created":{"date-parts":[[2016,5,7]],"date-time":"2016-05-07T15:29:45Z","timestamp":1462634985000},"page":"1040-1047","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Patient and Process Factors Associated With Type of First Neuroimaging and Delayed Diagnosis in Childhood Arterial Ischemic Stroke"],"prefix":"10.1111","volume":"23","author":[{"given":"Marco","family":"Daverio","sequence":"first","affiliation":[{"name":"Department of Woman's and Child's Health University of Padova Padova Italy"},{"name":"Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Bressan","sequence":"additional","affiliation":[{"name":"Department of Woman's and Child's Health University of Padova Padova Italy"},{"name":"Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Gregori","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics Epidemiology and Public Health Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz E.","family":"Babl","sequence":"additional","affiliation":[{"name":"Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute Melbourne Victoria Australia"},{"name":"Emergency Department Royal Children's Hospital Melbourne Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T.","family":"Mackay","sequence":"additional","affiliation":[{"name":"Emergency Research Group and Neuroscience Research Groups Murdoch Childrens Research Institute Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne Melbourne Victoria Australia"},{"name":"Department of Neurology Royal Children's Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/088307380001500508"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-013-0276-z"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60738-7"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.008384"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1411587"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.110.5.924"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2008.03012.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.519066"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-3544"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.10.013"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000343"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309188"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60151-2"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2242010873"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e318230a002"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.004919"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.2000.00004.x"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mop.0000144441.29899.20"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.3928\/0090-4481-19860101-05"},{"key":"e_1_2_8_22_1","unstructured":"Australasian College for Emergency Medicine.Policy on the Autralasian Triage Scale. 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