Paediatric code stroke in Queensland

Meet Dr Michaela Waak, one of the few paediatric specialists in the world with fellowships in paediatrics, neurology and paediatric intensive care medicine. Dr Waak and her team at Children’s Health Queensland are based at the Queensland Children’s Hospital in Brisbane, and she is connected to the University of Queensland.

Strokes can occur in all age groups, from newborns to older teenagers. Sometimes strokes occur in babies before they are born. An estimated one newborn in every 2,300 to 5,000 will have a stroke.

In the last few years, we’ve seen a focus on childhood stroke gain momentum, partly due to the tireless advocacy of the Little Stroke Warrior community.

Despite an historical lack of investment in paediatric stroke, a group of dedicated health professionals have been working tirelessly for a decade or more, to improve the delivery of stroke treatment for our youngest - and Dr Michaela Waak is one of these remarkable people.

Dr Waak is an academic intensivist (critical care physician), neurologist, and clinical researcher with a special interest in the impact of a neurocritical care program. She is focussed on acute stroke care, EEG monitoring on the brains of children, and the long-term outcomes for the child, family and community.

Dr Waak says, “I am a rare breed, in that I am trained in childhood neurology, intensive care and paediatrics. I work in a team with our stroke nurse (both research and clinical) and our childhood stroke physician. Even though stroke is relatively rare in children, when it does happen, it can have a huge impact on the child and family.”

She and her team, Dr Adriane Sinclair and Mrs Louise Sparkes, have led significant improvements in the acute care of children with stroke. Dr Waak and her team have performed audits to understand how hospitals are performing and have spearheaded research and the development of guidelines.

This includes the implementation of a paediatric code stroke process at the Queensland Children’s Hospital, which has helped the current development of state-wide and national protocols.

She says, “In our team we are passionate about improving outcomes for children and babies with stroke. Working with families and children inspires us. Saving even a little time to diagnosis and management, initially, can have a huge impact on how the child and family do over time.

The team's current research is focused on answering the very important question; do seizures contribute to the impact a stroke has on the brain, and what can be done to improve outcomes after stroke or a brain injury.

The projects focus mainly on children with stroke, but also include children admitted to intensive care with a brain injury, and have been running for five years.

Dr Waak and her team are linked with other researchers, including through the PICOLO network, an interdisciplinary team of researchers and families impacted by childhood stroke who are focused on making sure the projects meet the needs of families.

Read Spencer’s (pictured in the middle) stroke story.

She says, “Our research covers three main areas. Firstly, which patients with stroke are at high risk of seizures? How should they be monitored, and does early aggressive treatment improve the outcome?”

A key focus will be to determine how acute childhood stroke can be better recognised and managed by clinicians as part of code stroke, including for paramedics, GPs, emergency departments and inpatient wards.

The team also plans to co-develop a childhood stroke awareness campaign with patients and families, about how to ensure that children, families, kindies, schools, and healthcare providers know the signs and symptoms of stroke and that this is an absolute emergency.

Dr Waak says, “Families have taught us that no matter how mild or severe the impact of stroke is on the child, it affects the child and the whole family for a long time. Everyone can help raise stroke awareness – this is particularly important in babies and children, where making even small improvements can have a huge impact long-term.”

Here is a list of resources:
• My family’s stroke journey.
• Childhood stroke podcast.
• Children’s Health Queensland educational resources (health professionals).