Clinical care teams at WashU Medicine and St. Louis Children’s Hospital have developed and implemented a regional network infrastructure for rapid referral and transfer of children with suspected stroke to a children’s hospital equipped for pediatric stroke care. This network, created in partnership with Missouri Emergency Medical Services for Children and regional referring hospitals, strives to provide regional hospitals with the tools and resources needed to more efficiently respond to pediatric stroke, where “time is brain” and speed is of the essence, same as in adult stroke patients. The network was featured in a special report published in Stroke, which highlighted a total of five successful initiatives to implement pediatric stroke readiness measures in a range of settings across the country.
While the field of stroke care has seen significant improvements in the past decades, pediatric stroke presents a unique set of challenges. In general, it takes longer for pediatric patients to be diagnosed with stroke even when they get to a medical facility within a reasonable timeframe, delaying treatment and leading to potentially higher healthcare burden, as well as greater impact on patients and their families. This can be attributed to shortfalls in multiple areas including education on pediatric stroke, diagnosis and treatment experience, institutional protocols, system-level infrastructure, systems-of-care, processes and networks. Furthermore, there are only a few specialized pediatric stroke centers operating in the U.S.
However, changes and initiatives at the international, national and local levels are generating discussion and improvements in the field of pediatric stroke care. The International Pediatric Stroke Study (IPSS), a global child stroke registry and network that St. Louis Children’s Hospital and WashU Medicine have been a part of for over 15 years, has provided critical research infrastructure and clinical trial access for member institutions. And the American Heart Association and American Stroke Association included guidance about pediatric stroke for the first time in their 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. At the local level, some hospital systems and local governments have launched state-wide or regional efforts to enhance pediatric stroke readiness in their areas.
Among the initiatives highlighted in the Stroke special report was the Midwest pediatric stroke network spearheaded by Kristin Guilliams, MD, associate professor of neurology, of pediatrics and of radiology at WashU Medicine. The initiative, which began in 2021, involves three core components:
- Ongoing outreach to regional hospitals, providing education on pediatric stroke, developing guidelines and protocols and equipping regional hospitals to more quickly and accurately identify patients that require transport to a pediatric stroke center.
- Changes to the activation process for code strokes, allowing regional hospitals to quickly alert pediatric stroke specialists at St. Louis Children’s and WashU Medicine so that the teams can be fully prepared to receive the patients.
- The Stroke Early Launch program, which allows transport teams to provide expedited transfer of pediatric stroke patients from regional hospitals to St. Louis Children’s Hospital, where they can get comprehensive care—from initial diagnostic tests and thrombectomy treatments to clinical trials and rehabilitation programs.
“I am very proud that our stroke network has expanded access for children in our region to one of the leading pediatric stroke and thrombectomy centers in the country,” said Guilliams, who is associate director of the Division of Pediatric and Developmental Neurology and chief of the Section of Pediatric Neurocritical Care at WashU Medicine Neurology. “What this means is higher chances of eligibility for time-sensitive treatments and the potential for better recovery for more pediatric stroke patients.”
The efforts at St. Louis Children’s Hospital and other institutions highlighted in the special report provide promising models for continued expansion of pediatric stroke readiness, both locally and across the U.S. “It is wonderful to see such a wide range of pediatric stroke infrastructure successes,” Guilliams said. “I am excited to see how the pediatric stroke landscape will evolve so that we can provide the very best care for young stroke patients everywhere.”
Pearson R, Fraser S, Pabst L, Galardi MM, Guilliams K, Faux BM, Lee S, Bhayana K, Novakovic-White R, Schultz CH, Bobko J, Fullerton H, Jordan LC, Fox CK; with the Texas Governor’s EMS and Trauma Advisory Council (GETAC) Pediatric Stroke Task Force. Advancing Pediatric Stroke Readiness: Engaging Healthcare Systems to Optimize Care Delivery. Stroke. 2026 Aug;57(8):2555-2564. doi: 10.1161/STROKEAHA.126.055126. Epub 2026 Jul 27. PMID: 42507792; PMCID: PMC13410954.