Abstract 41: Care Seeking Behaviours in Childhood Arterial Ischemic Stroke

Objective: Taking appropriate action in the pre-hospital setting is important for rapid stroke diagnosis in adults but data are lacking for children. Our objectives were to describe help seeking behaviour and pathways to hospital in pediatric arterial ischemic stroke. Methods: A structured interview was performed to determine carer actions and pathway to hospital. Event driven process modeling techniques were used to develop questions with fundamental objectives being timely and correct recognition of stroke in the pre-hospital setting. Results: Parents of 28 children (61% female) were interviewed. 27 children (96%) were awake at stroke ictus and 26 (93%) had sudden onset symptoms. Child’s location at stroke onset included home 19 (68%), school 3 (11%) or other setting 6 (21%). Carers present included parent 21 (75%), teacher 2 (7%), other adult 4 (14%) or alone 1 (4%). 24 (89%) parents thought symptoms were serious but only 10 (36%) considered the possibility of stroke. Symptoms of most concern to parents included face weakness 14 (54%), speech disturbance 9 (32%), incoordination or difficulty walking 6 (21%), headache 5 (18%) and weakness 4 (14%). Initial actions included calling 911 in 10 (36%), wait and see 6 (21%), calling family member 1 (4%), private transport to emergency room (ER) 7 (25%) or family physician 4 (14%). 22 (85%) carers thought urgent action was required but only 14 (54%) ultimately called 911. First heath professional contact included paramedic 13 (46%), ER physician 8 (29%) or family physician 7 (25%). Median time from onset to ER arrival was 1.8 hours (IQR 0.75-7). Conclusions: Only one-third of carers considered stroke as a possible cause for their child’s neurological symptoms and less than half called 911. Initiatives are required to educate parents about taking appropriate action to improve access to time critical interventions.