Stroke in Childhood: Clinical guideline for diagnosis, management and rehabilitation (2017)

A nationally developed evidence-based clinical guideline for all UK paediatricians and healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke.

Stroke in Childhood

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About

The updated Stroke in Childhood evidence-based clinical and parent guidelines were published in May 2017.

Funded by the Stroke Association, the clinical guideline was prepared by the Royal College of Paediatric and Child Health’s (RCPCH) multi-professional Stroke in Childhood Guideline Development Group (GDG), chaired by Dr Vijeya Ganesan. The GDG was represented by 27 stakeholder organisations and included lay representation from three parents of affected children and young people. 

The clinical guideline is accompanied by a parent guideline, which aims to ensure that families understand what a stroke is, why they occur, and how children and young people affected by stroke should be treated and cared for.

A parent from the GDG talks of her experiences


 

Background

The first clinical guideline on stroke in childhood was published by the Royal College of Physicians (RCP) in 2004. These guidelines may no longer reflect the best and most up-to-date clinical practice, and as such required urgent updating to ensure utilisation of current evidence.

This 2017 iteration of the clinical guideline delivers an update and scope extension, and provides guidance on the identification, diagnosis, management and rehabilitation of children and young people (aged 29 days to 18 years at time of presentation) with arterial ischaemic stroke (AIS) and haemorrhagic stroke (HS).

Full clinical guideline 

This clinical guideline is the most comprehensive and up-to-date guidance on how stroke care should be provided, covering the whole pathway from identification, diagnosis and management of children and young people with AIS and HS until their transition to adult care.

The 2017 iteration is intended for use by all UK paediatricians and other healthcare professionals involved in the regulation or practice of the care of children and young people who have had or are suspected of having a stroke, as well as non-healthcare professionals involved with educational/social services. While sections may also be relevant to education and social care professionals, it is intended to inform clinical decision making.

RCPCH notes: On 1 June 2017, an amendment was made to the recommendations under the acute diagnosis (clinical presentation) section on page 24 of the full clinical guideline. The third recommendation relating to urgent brain imaging was revised to read 'Reduced level of consciousness (age-appropriate Glasgow Coma Scale (GCS) less than 12 or AVPU (‘Alert, Voice, Pain, Unresponsive’) less than V) at presentation'.

Guidelines summary

Working with the Guidelines Team this summary provides a concise overview for GPs on the management of stroke in childhood. 

Guidelines summary (weblink)

Key recommendations

The concise key recommendations guide contains 83 key recommendations identified by the RCPCH Stroke in Childhood GDG, which, if followed, will enhance the quality of stroke care in children and young people. 

These recommendations have been extracted from the clinical guideline, which contains over 250 individual recommendations covering the diagnosis, management and rehabilitation of stroke in children and young people. 

It is recommended that the concise key recommendations guide should not be read in isolation, and individuals should always consider the guideline in full.

Diagnosis algorithm poster

This print-friendly algorithm poster has been produced to accompany the clinical guideline and provides the user with the suggested pathway to identify and treat a childhood stroke.
 
It details information from how to identify a potential stroke, how to activate the acute stroke pathway through to treatment for AIS.

Parent/carer guideline 

This lay version of the guideline provides information to parents, carers, and families of children and young people affected by stroke. The information is based on detailed clinical guidelines produced for healthcare professionals who are involved in the care of children and young people affected by stroke.

The information is designed to help the reader understand what a stroke is, why strokes occur, and how children and young people affected by stroke should be treated and cared for. It describes the usual journey from diagnosis to rehabilitation that a child or young person will follow after a stroke and will outline what you should expect at each stage of treatment and rehabilitation.

Posters

Want to raise awareness that stroke happens to children and young people?

Contact

If you have any questions in relation to the development of this guideline, please contact us on clinical.standards@rcpch.ac.uk. For media queries, please contact us on press.office@rcpch.ac.uk and see the press release.