Primary pediatric stroke center in the multidisciplinary pediatric hospital. New reality in pediatrics

Background. The increase in the number of diagnosed strokes in children, significant distinctive features and complexity of diagnosis, treatment and prevention of cerebrovascular diseases in children compared with adults, the impossibility of direct extrapolation of therapeutic recommendations from adult practice to pediatrics required the creation of specialized primary centers of pediatric stroke in Russia. Purpose. The purpose of this article is to describe the experience of organizing a Center for the treatment of children and adolescents with cerebrovascular diseases (hereinafter referred to as the Center) on the basis of the multidisciplinary pediatric hospital of the Morozovskaya Children’s City Clinical Hospital of Moscow Healthcare Department, the introduction of modern methods of diagnosis and treatment of strokes in pediatrics, the organization of preventive measures, maintaining the city register of children’s stroke, coordinating the provision of medical care to children with cerebrovascular diseases at various levels in the city of Moscow. Materials and methods. The presented experience of organizing and operating the Center covers the period from 2014 to 2019. Researchers used descriptive, statistical, and comparative analysis to demonstrate the Center’s performance and justify proposed improvements in diagnostics, management of pediatric patients with cerebrovascular disease, and relapse prevention. Results. In the course of the organization and operation of the Center, there was assessed the frequency of children’s strokes in the city: in 2015 – 6.59 cases per 100 thousand of the child population of Moscow; in 2016 – 6.51 per 100 thousand; in 2017 – 6.43 per 100 thousand and in 2018 – 5.86 per 100 thousand. There were improved: the diagnostics of cerebrovascular pathology and its algorithm, modern reperfusion methods of treatment (thrombolysis, thromboextraction) were introduced into practice, outpatient observation. The equipment and trained specialists concentration on the basis of the Center allowed the creation of the Center «full cycle». Maintaining the city register of pediatric stroke made it possible to compare Russian data with those available in the literature and to establish international cooperation with the International Pediatric Stroke Organization. Conclusion. The establishment of the Center is an important example of interdisciplinary interaction in pediatrics. The City Register of Pediatric Stroke will make it possible to assess the problem of childhood stroke in Moscow. The accumulated organizational, medical and diagnostic, scientific, international and educational experience of the Center can be introduced in other regions of the Russian Federation to improve the provision of medical care to children and to solve the most important problem - preserving the health of the country’s child population.

1. Feigin V. L. et al. From the Global Burden of Disease Study 2010. 2014. Vol. 383, № 9913. P. 245–254.

2. Heron M. Deaths: leading causes for 2010 // Natl. Vital Stat. Rep. 2013. Vol. 62, № 6. P. 1–97.

3. deVeber GA, Kirton A., Booth FA, et al. Epidemiology and outcomes of arterial arterial ischemic stroke in children: the Canadian pediatric ischemic stroke registry. Pediart Neurol. 2017;68:58-70.

4. Matta AP, Galvao KR, Oliveira BS. Cerebrovascular disorders in childhood: etiology, clinical presentation, and neuroimaging findings in a case series study. Arq Neuropsiquiatr. 2006 Jun;64(2A):181-5.

5. Lynch JK, Hirtz DeVeber G, Nelson KB. Report of the National Institute of Neurological Disorders and stroke workshop on perinatal and childhood stroke. Pediatrics.2002;109:116-23.

6. Fullerton HJ, Wu YW, Zhao S, Johnston SC. Risk of stroke in children: ethnic and gender disparities. Neurology. 2003;61:189-94.

7. deVeber GA, MacGregor D, Curtis R, Mayank S. Neurologic outcome in survivors of childhood arterial ischemic stroke and sinovenous thrombosis. J Child Neurol 2000;15(5):316-24.

8. Гузева В. И. Руководство по детской неврологии. − М., 2009. − 640 с.

9. Roach E. S. et al. Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young // Stroke. 2008. Vol. 39, № 9. P. 2644–2691.

10. Mackay M.T., Churilov L., Donnan G.A., Babl F.E. & Monagle P. (2016). Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics. Neurology, 86(23), 2154-2161.

11. Mackay MT, Wiznitzer M, Benedict SL, et al. Arterial ischemic stroke risk factors: the International Pediatric Stroke Study. Ann Neurol 2011;69:130-140.

12. Rivkin MJ, deVeber G, Ichord RN, Kirton A, Chan AK, Hovinga CA, et al. Thrombolysis in pediatric stroke study. Stroke.2015;46(3):880-5.

13. Bernard TJ, Rivkin MJ, Scholz K. Emergence of the primary pediatric stroke center: impact of the thrombolysis in pediatric stroke (TIPS) trial. Stroke. 2014 July;45(7):2018-2023.

14. The diagnosis and acute management of childhood stroke, Clinical guideline, 2017.