Neuropediatrics 2025; 56(S 01): S1-S24
DOI: 10.1055/s-0045-1812130
Vascular Malformations/Disorders

Twenty-Year Trends in Time-to-Diagnosis of Paediatric Ischaemic Stroke in Switzerland

Authors

  • D. Brechbühl

    1   Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Abteilung Neuropädiatrie, Bern, Switzerland
    2   Graduate School for Health Sciences, University of Bern, Bern, Switzerland

  • B. Goeggel-Simonetti

    3   Istituto Pediatrico della Svizzera Italiana EOC, Division of Child Neurology, Bellinzona, Switzerland

  • C. Rothacher

    4   Department of Pediatric Neurology/Epileptology, University Children's Hospital Zurich, Zurich, Switzerland

  • F. Bauder

    5   Cantonal Hospital Winterthur, Social Paediatrics Center, Winterthur, Switzerland

  • G. Oesch-Nemeth

    1   Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Abteilung Neuropädiatrie, Bern, Switzerland

  • J. Fluss

    6   Geneva Children's Hospital, Pediatric Neurology Unit, Geneva, Switzerland

  • M. Bachmann

    7   Department of Child Neurology, Children's Hospital of Eastern Switzerland, Switzerland

  • N. Faignart

    8   Department of Pediatrics, Hôpital du Valais, Sion, Switzerland

  • S. Strozzi

    9   Department of Pediatrics, Kantonsspital Graubünden, Chur, Switzerland

  • R. Münger

    1   Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Abteilung Neuropädiatrie, Bern, Switzerland
    2   Graduate School for Health Sciences, University of Bern, Bern, Switzerland
    10   Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital Basel, Basel, Switzerland

  • S. Darteyre

    11   Lausanne University Hospital, Pediatric Neurology and Neurorehabilitation Unit, Lausanne, Switzerland

  • M. Steinlin

    1   Universitätsklinik für Kinderheilkunde, Inselspital, Universitätsspital Bern, Universität Bern, Abteilung Neuropädiatrie, Bern, Switzerland
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    Background/Purpose: Timely diagnosis of paediatric acute ischaemic stroke (AIS) is essential to enable revascularization therapies within thrombolysis (≤4.5 hours) and thrombectomy (≤24 hours) windows. However, diagnostic delays remain common, and little is known about how recognition and management have improved over time.

    Methods: Children aged 28 days to 16 years diagnosed with AIS between 2000 and 2023 were included from the nationwide Swiss Neuropaediatric Stroke Registry (SNPSR). Time from symptom onset to diagnosis (TOD), to admission (TOA), and from admission to diagnosis (TAD) was analysed. Multivariate regression models were used to adjust for potential confounders and assess temporal trends and predictors of delayed diagnosis.

    Results: Among 347 children, median TOD decreased from 38.2 hours (2000–2004) to 24.0 hours (2020–2023). The proportion diagnosed outside the thrombolysis window (>4.5 hours) declined from 91.1 to 76.3% (p = 0.044). In out-of-hospital cases, TOD dropped from 23.6 to 13.1 hours, with a corresponding decline in late diagnoses (88.1–73.1%). Faster diagnosis was associated with posterior circulation stroke symptoms, older age, higher PED-NIHSS scores, and direct presentation at a stroke centre, while nonspecific symptoms and isolated posterior circulation signs were linked to delays.

    Conclusion: Over the past two decades, diagnostic timeliness for paediatric AIS in Switzerland has improved substantially. Nonetheless, posterior circulation strokes and nonspecific presentations remain challenging. Further improvements may be achieved through systematic training and implementation of standardized paediatric stroke pathways in emergency settings.


     

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

    Publication History

    Article published online:
    26 September 2025

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