Abstract TP170: Pediatric Acute Stroke Team Activation: Differentiating Stroke From Mimics

Acute pediatric stroke is a medical emergency requiring prompt recognition and treatment because quicker treatment improves neurologic outcomes and reduces excess resource usage on stroke mimics (non-stroke diagnoses). There is a clear need to better differentiate between strokes and their mimics. We performed a single center retrospective cohort study using data from March 1, 2017 to December 31, 2020. We included pediatric patients (> 1m to < 18y) evaluated in the tertiary children’s hospital ED for a stroke team activation. We compared clinical features for patients with stroke and those with a stroke mimic. Of 179 children included in the study (55% female, mean age 11.2y, SD 5.7y), 38 children (21% of total patients, 50% female, mean age 10.5 SD, 6.2 years) were diagnosed with stroke. Strokes included acute ischemic stroke (AIS) (73.7%), hemorrhagic stroke (HS) (18.4%), and cerebral venous sinus thrombosis (CVST) (10.5%). The most common stroke mimics were seizure (14.5%), headache (10.5%), Bell's palsy (5.6%), and conversion disorder (2.7%). Compared to mimics, stroke patients were less likely to have a history of neurosurgery (16.3% mimic vs 2.6% stroke, p=0.028) and more likely to have altered level of alertness (7.7% vs 18.4%, p=0.001), abnormal coordination (15.7% vs 36.4%, p=0.036), abnormal muscle strength (33.1% vs 57.9%, p=0.005) and abnormal reflexes (18.9% vs 43.8%, p=0.018). Of note, there were no significant differences in stroke and mimics for: age, sex, race, ethnicity, basic metabolic panel or CBC, and time from last seen well. Differentiating between strokes and mimics remains difficult without comprehensive diagnostic testing. Our study found that stroke patients are more likely present with altered level of alertness as well as abnormal coordination, muscle strength, and reflexes.