Among 66 pediatric AIS patients, 53.03% presented late, with timely presenters more likely to arrive by ambulance (48.4% vs 22.9%, p=0.0398).
Are socioeconomic and geographic factors associated with delayed hospital presentation in pediatric acute arterial ischemic stroke?
Geographic proximity and mode of transport, rather than social vulnerability indices, are significantly associated with timely hospital presentation in pediatric arterial ischemic stroke.
Introduction: In acute arterial ischemic stroke (AIS), delayed hospital presentation and diagnosis are associated with worse outcomes. In adults, socioeconomic factors have been linked to these delays. Despite increased awareness of AIS in pediatrics, delayed hospital presentation remains an issue. The purpose of this study is to assess differences in socioeconomic and geographic factors between pediatric AIS patients at a single institution. Methods: A retrospective cohort study was approved by Cook Children's Medical Center (CCMC) institutional review board. Children (29 days – 18 years) treated for acute AIS March 1, 2018 – May 31, 2025, were categorized as delayed (symptom presentation >6 hours) or timely (<6 hours). Asymptomatic or inpatient AIS were excluded. Zip codes at admission were mapped to published social vulnerability indices (SVI). SVI and potential risk factors for delayed presentation were compared using SAS 8.3. Results: Two hundred twenty-three patients were reviewed and 66 met eligibility criteria. Patient demographics and medical history are summarized in Table 1. Thirty-five patients (53.03%) had delayed presentation. Compared to delayed presenters, timely presenters frequently arrived by ambulance (48.4% vs 22.9%, p=0.0398), presented to CCMC directly (61.3% vs 20.0%, p=0.0009), and lived closer to CCMC (median 24.5 km vs 400.5 km, p<0.0001). SVI did not show statistically significant differences between groups. Cryptogenic strokes were more common among delayed presenters (25.7% vs 6.7%; p=0.0489) and notably, 4 patients (3 in delayed) did not undergo any neuroimaging at the non-CCMC site. Conclusion: In conclusion, SVI did not show disparities, suggesting equitable access to a pediatric stroke center in our community. However, findings indicate a continued need for community education on pediatric stroke symptoms and recognition, even in children with no prior medical history. Increasing community awareness and strengthening collaboration among regional hospitals may improve timeliness of pediatric stroke diagnosis. However, further research is needed.
Kovvuru et al. (2026) studied this question. Among 66 pediatric AIS patients, 53.03% presented late, with timely presenters more likely to arrive by ambulance (48.4% vs 22.9%, p=0.0398).