A Review of an Interfacility Transport Program Pediatric Stroke Clinical Practice Guideline.

BACKGROUND: Pediatric acute ischemic stroke is a rare diagnosis that requires timely recognition and definitive management to prevent morbidity and mortality. Children often present to primary care offices, urgent care clinics, and adult emergency departments for evaluation of symptoms that may be signs and symptoms of stroke. Currently, there are no published prehospital or transport protocols specific to pediatric acute ischemic stroke. The Children's Mercy Hospital Critical Care Transport Team (CMCCT) created a pediatric-specific clinical practice guideline (CPG) for suspected acute ischemic stroke. METHODS: This retrospective, descriptive study reports pediatric patients aged younger than 18 years who met criteria for the pediatric stroke CPG and required interfacility transport by CMCCT over a 4- year period. Large vessel occlusion (LVO) scores used in adults were calculated retrospectively. RESULTS: Seventeen patients met inclusion criteria. Four (24%) of 17 had radiographic evidence of acute thrombus, 3 of whom received alteplase and/or endovascular clot retrieval. Median age of confirmed stroke was 83 months (interquartile range, 65-148) compared with 177 months for nonstroke (interquartile range, 169-191), P = 0.126. The most common presenting symptom was hemiplegia in the confirmed stroke group. The confirmed stroke group scored significantly lower on the Glasgow Coma Scale (median of 8 vs 15, P = 0.014), significantly higher on the Los Angeles Motor Scale LVO score (median 4 vs 0, P = 0.021), and significantly higher on the Rapid Arterial Occlusion Evaluation LVO (median 4 vs 0, P = 0.036). CONCLUSIONS: To our knowledge, the CMCCT CPG is the first pediatric transport protocol aimed at recognition and management of pediatric stroke described in the literature. Retrospective calculation of LVO scores show that they may be helpful in application to pediatric patients.

Comparative healthcare use by adolescents screening positive for sexual exploitation.

BACKGROUND: Although screens for commercial sexual exploitation of children (CSEC) have been developed, little is known about how adolescents at high risk for, or victims of, CSEC compared to non-CSEC adolescents in healthcare utilization as previous studies have not included a control group. OBJECTIVE: Identify where and how often CSEC adolescents presented to medical care in 12 months prior to being identified as compared to non-CSEC adolescents. PARTICIPANTS AND SETTING: Adolescents between 12 and 18 years seen in a tertiary pediatric health care system in a Midwestern city with a metropolitan population of >2 million. METHODS: This was a 46-month retrospective case-control study. Cases included adolescents who screened high risk or positive for CSEC. Control group 1 included adolescents who screened negative for CSEC. Control group 2 were adolescents who were not screened for CSEC, matched to cases and to control group 1. The three study groups were compared for frequency of, location of, and diagnosis given for medical visits. RESULTS: There were 119 CSEC adolescents, 310 CSEC negative, and 429 unscreened adolescents. Compared to the controls, CSEC positive adolescents sought care less frequently (p < 0.001) and were more likely to present to an acute care setting (p < 0.0001). CSEC cases sought medical care in the acute setting more commonly for inflicted injuries (p < 0.001), mental health (p < 0.001), and reproductive health (p = 0.003). In primary care, CSEC adolescents were more commonly seen for reproductive health (p = 0.002) and mental health (p = 0.006). CONCLUSIONS: CSEC adolescents differ from non-CSEC adolescents in frequency, location, and reasons for seeking healthcare.