Emergency Department and PICU Clinical Pathway
for Stroke Management

 
 
 
 
 
 
High Concern
 
 
Low Concern
  • Further care, Neurology consult as clinically indicated
 
 
 
 
Persistent
Neurologic Symptoms/Deficits
Resolution of
Neurologic Symptoms/Deficits
  • Obtain imaging per discussion with Stroke Team with CT or MRI
  • Imaging per ED/Neurology Discussion
 
 
 
 
  • Continue neuroprotective intervention
  • Discuss further care with Stroke Team
    • Antithrombosis
    • Anticonvulsants
    • Special cases
  • Initial Treatment Guidelines
  • Normal CT or MRI
  • Reassess symptoms
  • Discuss disposition with Stroke Team
 
 
 
 
Admit ICU
Admit to Neurology/ICU or
discharge to home
Stroke Screening Questions
  • Is there a focal neurologic deficit?
    • Unilateral weakness or sensory change
    • Vision loss, double vision
    • Speech difficulty
    • Dizziness or trouble walking
    • New onset seizures with focal findings
  • Did the problem begin or get worse suddenly?
    • What was the time of symptom onset?
    • When was child last seen symptom free?
  • When did the child last eat or drink?
  • Does the child have dental hardware?