Impact of the Thrombolysis in Pediatric Stroke Trial

1In adult stroke, clinical trials have resulted in 2 evidence-based acute stroke treatment guidelines that save lives and improve neurological outcome: the use of tissue-type plasminogen activator (tPA)1 and the development of dedi-cated stroke units that provide standardized, best practice acute care.2 Following the approval of tPA for the treatment Background and Purpose—In adult stroke, the advent of thrombolytic therapy led to the development of primary stroke centers capable to diagnose and treat patients with acute stroke rapidly. We describe the development of primary pediatric stroke centers through preparation of participating centers in the Thrombolysis in Pediatric Stroke (TIPS) trial. Methods—We collected data from the 17 enrolling TIPS centers regarding the process of becoming an acute pediatric stroke center with capability to diagnose, evaluate, and treat pediatric stroke rapidly, including use of thrombolytic therapy. Results—Before 2004, <25 % of TIPS sites had continuous 24-hour availability of acute stroke teams, MRI capability, or stroke order sets, despite significant pediatric stroke expertise. After TIPS preparation,>80 % of sites now have these systems in place, and all sites reported increased readiness to treat a child with acute stroke. Use of a 1- to 10-Likert scale on which 10 represented complete readiness, median center readiness increased from 6.2 before site preparation to 8.7 at the time of site activation (P≤0.001)