Understanding the Varying Uses of Thrombolysis in Pediatric Stroke Settings: Kristin Guilliams, MD, MSCI

WATCH TIME: 4 minutes

"I think it can be a good think, in that all the hospitals are working towards what’s best for a patient that comes into our hospital today. Where children or any patient get into a bit of danger is when people start doing things that they’re not comfortable with, or if they’re charting to push boundaries beyond what would generally be accepted."

Ischemic stroke in the pediatric population is rare; however, stroke in children in the acute setting can be missed because of its low prevalence. Care for acute pediatric strokes involves determining the most likely etiology in a timely manner, understanding available resources, and making the best choice based on the information at hand, according to Kristin Guilliams, MD, MSCI. Guilliams, an associate professor at Washington University School of Medicine, recently gave a talk on tailoring hyperacute management of stroke in the pediatric population at the recently concluded 2023 American Neurological Association (ANA) Annual Meeting, held September 9-12, in Philadelphia, Pennsylvania.

In her presentation, she broke down the ABCs of treating pediatric stroke, which include Airway, Arterial Oxygen Content, Breathing, Blood pressure, Circulation, and Coagulation. In addition, she covered why some institutions have different risk benefit analyses for thrombolysis, stating that some will give thrombolysis if the ischemic stroke is confirmed on MRI imaging while others may only require a high suspicion of ischemic stroke and no known risk factors to initiate treatment. Furthermore, some only give thrombolysis to teenagers with rationale of being biologically more similar to young adults in stroke trials.

At the meeting, Guilliams sat down with NeurologyLive® to discuss her presentation, and the reasons for why institutions vary in their care of pediatric stroke. She broke down why this can be a good thing, stating that comfortability is key for clinicians as long as they are staying within their medical practice boundaries. In addition, she provided commentary on the importance of timing when initiating treatment for pediatric stroke, and what clinicians should refer to if they’re unsure about a patient’s last well known.