A Retrospective Single-center Study on Time Critical Neurological Disorders in the Emergency Room of a Tertiary Pediatric Center

Background: Teams of pediatric emergency rooms (ER) are very often confronted with patients presenting due to acute neurological symptoms. Disorders include several less time critical diseases (i.e. migraine) as well as some less commonly encountered conditions, that however demand for a very urgent management (i.e. childhood stroke). In this context, the subgroup of children presenting due to acute onset focal neurological symptoms represent a very important subgroup (keyword: brain attack (BA). In our ER, triage of patients is based on the emergency severity index (ESI) und the Face-Arm-Speech-Time-test (FAST), an adult stroke screening tool that has been evaluated in children previously. So far, no sufficiently sensitive tool exists to recognize or discriminate childhood brain attacks promptly and efficiently. The aim of this study was the investigation of more recent tools as the Balance-Eyes-FAST-test (BEFAST) and the Munich Early Recognition of Childhood Stroke (MERCS) – a pocket card developed by our working group to optimize the management pathways for children presenting with BA.

Objective: We report the prevalence of health care utilization delivered by our ER due to acute neurological conditions focusing on the prevalence, symptoms and etiology of BA. BEFAST and MERCS are assessed in this subgroup.

Methoden: Retrospective, uncontrolled chart review covering a 6 months episode. Patients have been categorized as BA+ or BA- according to previous reports of Mckay et al.

Ergebnisse: 258 presentations to the ER were analyzed. The top 4 main neurological symptom were headache, seizure, paresis and syncope. A neurological disorder was diagnosed in 60% of those patients. Top 5 neurological disorders were seizure, headache, syncope, Bell’s palsy and infection of the central nervous system. 60% of patients were classified as BA+. In this subgroup FAST was positive in 24 patients and BEFAST in 68 patients (+180% vs. „FAST solo“), respectively. Concerning MERCS ≥1 criteria was positive in 127 patients.

Discussion and Conclusion: A triage based solely on the FAST misses a relevant number of BA+ patients. Consequently, those patients are not adequately urgently managed. BEFAST can be considered a reasonable update for pediatric emergency triage-protocols. MERCS seems to effectively structure the assessment of children presenting with acute neurological symptoms to efficiently recognize time critical conditions. A prospective controlled multicenter trial should be initiated.

Limitation: As critically ill patients are directly admitted to our pediatric intensive care unit, those patients are not included in this analysis.

No conflict of interest has been declared by the author(s).