Öz
Evaluation of Pediatricians’ Awareness, Interest and Knowledge Levels Regarding Stroke
Objective: Acute childhood stroke is a medical emergency requiring a high level of awareness. This study aims to evaluate pediatricians’ awareness, interest, and knowledge regarding childhood stroke.
Methods: Physicians working in various centers across Turkey were invited via email to participate in an online survey on childhood stroke.
Results: The study was conducted with a total of 133 participants. Among them, 86 (64.7%) were pediatric residents, and 47 (35.3%) were pediatric specialists. A total of 42.1% of participants reported considering childhood stroke as a diagnosis at least once in the past year, and 39.8% stated that they had been involved in the follow-up and treatment of patients with childhood stroke. The FAST (Face-Arm-Speech-Time) mnemonic, used for recognizing stroke symptoms, was known by 50.4% of pediatricians. The most frequently reported symptoms of childhood stroke were hemiparesis (55.6%), altered consciousness (36.1%), speech disorders (30.1%), seizures (28.6%), visual impairment (20.3%), headache (15%), and syncope (6.8%). The most common stroke mimics identified were central nervous system infections (40.6%), seizures (21.1%), hypoglycemia (8.3%), and migraines (7.5%). The primary diagnostic tools used were magnetic resonance imaging (MRI) (55.6%) and computed tomography (CT) (42.9%). The main treatment strategies included anticoagulants (39.1%), thrombolytics (22.6%), antiplatelets (11.3%), and thrombectomy (6%). Among the participants, 81.7% had conducted online research on childhood stroke, 15.9% had discussed the topic with colleagues, and 2.4% had attended educational sessions.
Conclusion: Early diagnosis and treatment of childhood stroke are crucial for prognosis. Increasing pediatricians’ awareness and knowledge on this topic is essential.
Keywords: Pediatrician, awereness, stroke
Anahtar Kelimeler
Kaynakça
- 1. M, Karukonda V, Aghaeeaval M, et al. A quantitative EEG index for the recognition of arterial ischemic stroke in children. Clin Neurophysiol. 2023; 156:113-124.
- 2. Lynch JK. Cerebrovascular disorders in children. Curr Neurol Neurosci Rep 2004;4(2):129-38.
- 3. Greenham M, Gordon A, Anderson V, Mackay MT. Outcome in childhood stroke. Stroke (2016) 47:1159–64.
- 4. Plumb P, Seiber E, Dowling MM, Lee J, Bernard TJ, deVeber G, et al. Out-of-pocket costs for childhood stroke: the impact of chronic illness on parents’ pocketbooks. Pediatr Neurol. (2015) 52:73.e2–6.e2.
- 5. Rafay MF, Shapiro KA, Surmava AM, et al. Spectrum of cerebral arteriopathies in children with arterial ischemic stroke. Neurology. 2020;94(23):e2479-e2490.
- 6. Kumar R, Shukla D, Mahapatra AK. Spontaneous intracranial hemorrhage in children. Pediatr Neurosurg. 2009;45(1):37-45.
- 7. Shack M, Andrade A, Shah-Basak PP, Shroff M, Moharir M, Yau I, et al. A pediatric institutional acute stroke protocol improves timely access to stroke treatment. Dev Med Child Neurol. (2017) 59:31–7.
- 8. Sun LR, Lynch JK. Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke. Neurotherapeutics. 2023;20(3):633-654.
- 9. Alloush R, Eldin NS, El-Khawas H, et al. Pediatric vs. adult stroke: comparative study in a tertiary referral hospital, Cairo, Egypt. Egypt J Neurol Psychiatr Neurosurg. 2022;58(1):82.
- 10. Lauzier DC, Galardi MM, Guilliams KP, et al. Pediatric Thrombectomy: Design and Workflow Lessons From Two Experienced Centers. Stroke. 2021;52(4):1511-1519.
- 11. McMahon SR, Iwamoto M, Massoudi MS, Yusuf HR, Stevenson JM, David F, et al. Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics (2003) 111(4 Pt 1), e299–303.
- 12. Gerstl L, Bonfert MV, Nicolai T, Dieterich M, Adamczyk C, Heinen F, et al. Childhood stroke : what are the special features of childhood stroke?. Nervenarzt (2017) 88:1367–76.
- 13. Phelps K, Silos C, De La Torre S, et al. Establishing a pediatric acute stroke protocol: experience of a new pediatric stroke program and predictors of acute stroke. Front Neurol. 2023;14:1194990. Published 2023 May 18.
- 14. Gerstl L, Weinberger R, Heinen F, et al. Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015–2017. J Neurol. 2019;266(12):2929–2941.
- 15. Mallick A, Ganesan V, Kirkham FJ, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13:35–43.
- 16. Hori I, Tsuji T, Miyake M, et al. Delayed recognition of childhood arterial ischemic stroke. Pediatr Int. 2019;61(9):895-903.
- 17. Mackay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Differentiating childhood stroke from mimics in the emergency department. Stroke (2016) 47:2476–81.
- 18. Nemati H, Behrad L, Esmaeil Zadeh H, Mahdizadegan N, Paktinat M. Pediatric Stroke in the Southern Region of Iran: A Retrospective Prognostic Cohort Study. Iran J Child Neurol. 2023;17(1):55-64.
- 19. Xiong X, Huang L, Herd DW, et al. Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized Controlled Trial. Neurology. 2023;100(24):e2432-e2441.
- 20. Monagle P, Newall F, Barnes C, et al. Arterial thromboembolic disease: a single-centre case series study. J Paediatr Child Health 2008; 44: 28–32.
- 21. Sotardi ST, Alves CAPF, Serai SD, et al. Magnetic resonance imaging protocols in pediatric stroke. Pediatr Radiol. 2023;53(7):1324-1335.
- 22. Kenet G, Lutkhoff LK, Albisetti M, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation 2010; 121: 1838–1847.
- 23. Boelman C, Shroff M, Yau I, et al. Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children. J Pediatr 2014; 165: 799–806.
- 24. Pero G, Ruggieri F, Macera A, et al. Endovascular treatment of acute ischemic stroke in childhood: A comprehensive literature review based on the experience of a single center. Eur J Radiol Open. 2023;11:100528.
- 25. Jamtli B, Hov MR, Jørgensen TM, et al. Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emerg Med. 2024;24(1):43. Published 2024 Mar 14.
- 26. .Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke (2017) 48:479–81.
- 27. DeLaroche AM, Sivaswamy L, Farooqi A, Kannikeswaran N. Pediatric stroke clinical pathway improves the time to diagnosis in an emergency department. Pediatr Neurol. (2016) 65:39–44.
- 28. Robinson TG, Reid A, Haunton VJ, Wilson A, Naylor AR. The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? Emerg Med J. (2013) 30:467–71.
Öz
Pediatristlerin İnme Konusunda Farkındalık, İlgi ve Bilgi Düzeylerinin Değerlendirilmesi
Amaç: Akut çocukluk çağı inmesi, yüksek düzeyde farkındalık gerektiren acil bir durumdur. Bu çalışma, pediatristlerin çocukluk çağı inmesi konusundaki farkındalığının, ilgi ve bilgisinin değerlendirilmesi amacıyla hazırlanmıştır.
Yöntem: Türkiye’nin çeşitli merkezlerinde çalışan doktorlar e-posta yoluyla çocukluk çağı inmesi hakkında online bir ankete davet edildi.
Bulgular: Çalışma toplam yüz otuz üç katılımcıyla gerçekleştirildi. Çalışmaya katılanların 86’sı pediatri asistanı (%64,7) ve 47’si pediatri uzmanı (%35.3) olarak görev yapmaktadır. Katılımcıların %42,1'i geçtiğimiz yıl içinde en az bir kez çocukluk çağı inmesini tanı olarak düşündüklerini belirttiler ve %39,8'i çocukluk çağında inme geçirmiş hastaların takip ve tedavilerini yaptıklarını ifade ettiler. İnmenin semptomatik kısaltması olarak adlandırılan FAST (Face-Arm-Speech-Time-Test) anımsatıcısı pediatristlerin %50,4'ü tarafından duyulmuştur. Katılımcılar tarafından çocukluk çağı inmesinin en sık semptomları hemiparezi (%55,6), bilinç bulanıklığı (%36,1), konuşma bozukluğu (%30,1), nöbet (%28,6), görme bozukluğu (%20,3), baş ağrısı (%15) ve senkop (%6,8) olarak belirtilmiştir. Merkezi sinir sistemi enfeksiyonları (%40,6), nöbet (%21,1), hipoglisemi (%8,3) ve migren (%7,5) en sık inme taklitleri olarak değerlendirilmiştir. Başlıca tanı ölçütleri manyetik rezonans görüntüleme (MRG) (%55,6) ve bilgisayarlı tomografi (BT) (%42,9) kullanılmaktadır. Ana tedavi stratejileri antikoagülan (%39,1), trombolitik (%22,6), antitrombositik (%11,3) ve trombektomi (%6) olarak saptanmıştır. Katılımcıların %81,7'si çocukluk çağı inmesi hakkında internet araştırması yapmış, %15,9'u meslektaşlarıyla tartışmış, %2,4'ü eğitim oturumlarına katılmıştır.
Sonuç: Çocukluk çağı inmesinin erken tanı ve tedavisi prognoz açısından oldukça önemlidir. Pediatristlerin bu konuda farkındalık ve bilgi düzeyinin arttırılması gerekmektedir.
Anahtar Kelimeler: Pediatrist, farkındalık, inme
Anahtar Kelimeler
Kaynakça
- 1. M, Karukonda V, Aghaeeaval M, et al. A quantitative EEG index for the recognition of arterial ischemic stroke in children. Clin Neurophysiol. 2023; 156:113-124.
- 2. Lynch JK. Cerebrovascular disorders in children. Curr Neurol Neurosci Rep 2004;4(2):129-38.
- 3. Greenham M, Gordon A, Anderson V, Mackay MT. Outcome in childhood stroke. Stroke (2016) 47:1159–64.
- 4. Plumb P, Seiber E, Dowling MM, Lee J, Bernard TJ, deVeber G, et al. Out-of-pocket costs for childhood stroke: the impact of chronic illness on parents’ pocketbooks. Pediatr Neurol. (2015) 52:73.e2–6.e2.
- 5. Rafay MF, Shapiro KA, Surmava AM, et al. Spectrum of cerebral arteriopathies in children with arterial ischemic stroke. Neurology. 2020;94(23):e2479-e2490.
- 6. Kumar R, Shukla D, Mahapatra AK. Spontaneous intracranial hemorrhage in children. Pediatr Neurosurg. 2009;45(1):37-45.
- 7. Shack M, Andrade A, Shah-Basak PP, Shroff M, Moharir M, Yau I, et al. A pediatric institutional acute stroke protocol improves timely access to stroke treatment. Dev Med Child Neurol. (2017) 59:31–7.
- 8. Sun LR, Lynch JK. Advances in the Diagnosis and Treatment of Pediatric Arterial Ischemic Stroke. Neurotherapeutics. 2023;20(3):633-654.
- 9. Alloush R, Eldin NS, El-Khawas H, et al. Pediatric vs. adult stroke: comparative study in a tertiary referral hospital, Cairo, Egypt. Egypt J Neurol Psychiatr Neurosurg. 2022;58(1):82.
- 10. Lauzier DC, Galardi MM, Guilliams KP, et al. Pediatric Thrombectomy: Design and Workflow Lessons From Two Experienced Centers. Stroke. 2021;52(4):1511-1519.
- 11. McMahon SR, Iwamoto M, Massoudi MS, Yusuf HR, Stevenson JM, David F, et al. Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics (2003) 111(4 Pt 1), e299–303.
- 12. Gerstl L, Bonfert MV, Nicolai T, Dieterich M, Adamczyk C, Heinen F, et al. Childhood stroke : what are the special features of childhood stroke?. Nervenarzt (2017) 88:1367–76.
- 13. Phelps K, Silos C, De La Torre S, et al. Establishing a pediatric acute stroke protocol: experience of a new pediatric stroke program and predictors of acute stroke. Front Neurol. 2023;14:1194990. Published 2023 May 18.
- 14. Gerstl L, Weinberger R, Heinen F, et al. Arterial ischemic stroke in infants, children, and adolescents: results of a Germany-wide surveillance study 2015–2017. J Neurol. 2019;266(12):2929–2941.
- 15. Mallick A, Ganesan V, Kirkham FJ, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014;13:35–43.
- 16. Hori I, Tsuji T, Miyake M, et al. Delayed recognition of childhood arterial ischemic stroke. Pediatr Int. 2019;61(9):895-903.
- 17. Mackay MT, Yock-Corrales A, Churilov L, Monagle P, Donnan GA, Babl FE. Differentiating childhood stroke from mimics in the emergency department. Stroke (2016) 47:2476–81.
- 18. Nemati H, Behrad L, Esmaeil Zadeh H, Mahdizadegan N, Paktinat M. Pediatric Stroke in the Southern Region of Iran: A Retrospective Prognostic Cohort Study. Iran J Child Neurol. 2023;17(1):55-64.
- 19. Xiong X, Huang L, Herd DW, et al. Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized Controlled Trial. Neurology. 2023;100(24):e2432-e2441.
- 20. Monagle P, Newall F, Barnes C, et al. Arterial thromboembolic disease: a single-centre case series study. J Paediatr Child Health 2008; 44: 28–32.
- 21. Sotardi ST, Alves CAPF, Serai SD, et al. Magnetic resonance imaging protocols in pediatric stroke. Pediatr Radiol. 2023;53(7):1324-1335.
- 22. Kenet G, Lutkhoff LK, Albisetti M, et al. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation 2010; 121: 1838–1847.
- 23. Boelman C, Shroff M, Yau I, et al. Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children. J Pediatr 2014; 165: 799–806.
- 24. Pero G, Ruggieri F, Macera A, et al. Endovascular treatment of acute ischemic stroke in childhood: A comprehensive literature review based on the experience of a single center. Eur J Radiol Open. 2023;11:100528.
- 25. Jamtli B, Hov MR, Jørgensen TM, et al. Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emerg Med. 2024;24(1):43. Published 2024 Mar 14.
- 26. .Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, Time): Reducing the Proportion of Strokes Missed Using the FAST Mnemonic. Stroke (2017) 48:479–81.
- 27. DeLaroche AM, Sivaswamy L, Farooqi A, Kannikeswaran N. Pediatric stroke clinical pathway improves the time to diagnosis in an emergency department. Pediatr Neurol. (2016) 65:39–44.
- 28. Robinson TG, Reid A, Haunton VJ, Wilson A, Naylor AR. The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? Emerg Med J. (2013) 30:467–71.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Çocuk Nörolojisi |
| Bölüm | ORİJİNAL MAKALELER / ORIGINAL ARTICLES |
| Yazarlar | |
| Yayımlanma Tarihi | 2 Mayıs 2025 |
| Gönderilme Tarihi | 13 Şubat 2025 |
| Kabul Tarihi | 29 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 47 Sayı: 3 |