Prevalence and structure of calls from the Moscow emergency medical team to children with stroke

The constant increase in cases of arterial ischemic stroke requires the development of algorithms for the diagnosis and management of stroke patients. Currently, there are no effective methods for diagnosing arterial ischemic stroke (AII) in children at the stage of emergency medical care (SMP). In 2020, the Prehospital Stroke Diagnosis Scale (DDI) was developed, which may be the optimal algorithm for prehospital diagnosis of childhood stroke.

The purpose of the study. To determine the optimal algorithm for prehospital diagnosis of arterial ischemic stroke in children. Objectives of the study: To determine the frequency of occurrence of «masks» of stroke and separately migraine in the structure of cases of hospitalization with suspected ONMC. To evaluate cases of hospitalization with confirmed diagnoses of ischemic stroke and migraine on the DDI Scale. To determine the statistical indicators of the effectiveness of the DDI Scale as the optimal algorithm for prehospital diagnosis of stroke in children.

Materials and methods. 401 cases of hospitalization of children to the Center via the NSR channel with symptoms of ONMC for the period from June 2023 to June 2024 were analyzed. All patients were evaluated by the staff of the NSR and the doctors of the Center on the DDI scale. Statistical data on the effectiveness of the DDI Scale are determined.

The results of the study. «Masks» of stroke in the structure of cases of hospitalization with suspected ONMC are detected in 94.26 %. Migraine is the main «mask» of AII and is detected in 69 % of cases of stroke «masks» and in 65.05 % of cases among all children with suspected ONMC. High indicators of the effectiveness of the DDI Scale in the differential diagnosis of AII and migraine in children have been established: sensitivity 96 % and specificity 95 %.

Conclusion. Thus, the DDI scale can be used as an effective algorithm for diagnosing AII in children, used by NSR staff.

1. Ferriero, D. M., Fullerton, H. J., Bernard, T. J., Billinghurst, L., Daniels, S. R., DeBaun, M. R., & American Heart Association Stroke Council and Council on Cardiovascular and Stroke Nursing. (2019). Management of stroke in neonates and children: a scientific statement from the American Heart Association / American Stroke Association. Stroke, 50(3), e51-e96. https://doi.org/10.1161/STR.0000000000000183Stroke. 2019; 50: e51–e96.

2. Shchederkina IO, Livshits MI, Kessel AE, Plavunov NF, Kuznetsova AA, Khachaturov YA, Vitkovskaya IP, Khasanova KA, Lim RT, Sidorov AM, Tenovskaya TA, Asalkhanova SB, Gorev VV. Stroke in children: experience of the Center for the Treatment of Cerebrovascular Diseases in Children and Adolescents in Moscow. S. S. Korsakov Journal of Neurology and Psychiatry = Zhurnal nevrologii i psikhiatrii imeni S. S. Korsakova. 2023;123(8 vyp 2):22–31. (In Russ.). https://doi.org/10.17116/jnevro202312308222.

3. Shchederkina I. O. Stroke and cerebrovascular pathology in children and adolescents: a guide for doctors – Moscow: GEOTAR-Media, 2022–27 p., 389 p.

4. Shchederkina I. O. et al. Stroke in children. Formation of the pediatric stroke registry: international and regional experience // Russian Journal of Pediatric Neurology. – 2018. – vol. 13. – No. 1. – pp. 7–19.

5. Khachaturov Yu. A., Shchederkina I. O., Plavunov N. F., Vlasov P. N., Kuleshov N. N., Sidorov A. M., Kessel A. E., Gorev V. V., Livshits M. I., Kadyshev V. A., Oleinikov B. I. Stroke in children and adolescents. Journal of Neurology and Psychiatry named after S. S. Korsakov. 2022;122(12 issue 2):76–83. https://doi.org/10.17116/jnevro202212212276.

6. Rafay M. F., Pontigon A. M., Chiang J., Adams M., Jarvis D. A., Silver F. & DeVeber G.A. (2009). Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke, 40(1), 58–64. https://doi.org/10.1161/STROKEAHA.108.519066.

7. Hori, I., Tsuji, T., Miyake, M., Ueda, K., Kataoka, E., Suzuki, M., … & Natsume, J. (2019). Delayed recognition of childhood arterial ischemic stroke. Pediatrics International, 61(9), 895–903. https://doi.org/10.1111/ped.13966.

8. Mackay M. T., Lee M., Yock-Corrales A., Churilov L., Donnan G. A., Monagle P. & Babl F. E. (2018). Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department. Developmental Medicine & Child Neurology, 60(11), 1117–1122. https://doi.org/10.1111/dmcn.13772.

9. Khachaturov Yu. A., I. O. Shchederkina, A. M. Sidorov, N. F. Plavunov, E. E. Petryaykina, V. A. Kadyshev, I. P. Vytkovskaya (2020) Diagnosis of stroke in children. An analysis of the work of the first aid station in Moscow and the primary pediatric stroke center. Zhurnal nevrologii i psikhiatrii imeni S. S. Korsakova 120(8–2), 65–7 (In Russ.). https://DOI.org/10.17116/jnevro202012008265.

10. Khachaturov Yu. A. et al. Comparative analysis of screening scales for prehospital diagnosis of arterial ischemic stroke in children // Child and adolescent rehabilitation. – 2024. – № 1(51). – P. 45–51.