Nondiagnostic Initial Head CT Delays the Diagnosis of Childhood Arterial Ischemic Stroke

To investigate the impact of initial neuroimaging on time to diagnosis of childhood stroke, a retrospective review was performed of 130 children who sustained arterial ischemic stroke in the outpatient setting. The median time from symptom onset to stroke diagnosis was 18.3 hours (IQR: 7.7, 31.9) in 60 children with an initial nondiagnostic head computed tomography (CT), 13.9 hours (IQR: 3.4, 34.7) in 36 children with initial diagnostic head CT, and 13.9 hours (IQR: 7.1, 28.6) in 34 children with initial head magnetic resonance imaging (MRI). The time to diagnosis from emergency department presentation for patients with nondiagnostic head CT (median: 10.5 hours, IQR: 4.6, 22.2) was significantly longer than patients with diagnostic head CT (median: 0.9 hours, IQR: 0.5, 1.9; difference: -9.6 hours; 95% CI: -14.5, -6.7) or initial MRI (median: 3.1 hours, IQR: 1.6, 5.2; difference: -7.4 hours; 95% CI: -12.3, -4.1). Obtaining an initial nondiagnostic head CT was associated with delayed diagnosis of childhood stroke.