Valeria Valencia-Cifuentes ^1,2* Natalia Llanos-Leyton ³ Maria Camila Gomez Ayala ³ Camila Ariza-Insignares ^2,4 Julian Alejandro Rivillas ^1,2,5 Ana Maria Granados ^2,6 Juan Camilo Márquez ^2,6 Laura Galvis Blanco ^2,4,7 Santiago Cruz-Zamorano ^2,4,8 Juan Fernando Gomez-Castro ^2,4,8 Rubén Eduardo Lasso ^2,4,9 Juan Manuel Castro Varela ² Luis Miguel Rámirez Muñoz ² Paula Andrea Benavides Llano ^2,4 Pablo Amaya ^1,2*

• ¹ Servicio de Neurología, Fundación Valle del Lili, Cali, Colombia
• ² Departamento de Ciencias Clínicas, Universidad Icesi, Cali, Colombia
• ³ Centro de Investigaciónes Clínicas, Fundación Valle del Lili, Cali, Colombia
• ⁴ Servicio de Medicina Materno-Infantil, Fundación Valle del Lili, Cali, Cauca, Colombia
• ⁵ Departamento de Salud Pública y Medicina Comunitaria, Universidad Icesi, Cali, Colombia
• ⁶ Servicio de Radiología, Fundación Valle del Lili, Cali, Colombia
• ⁷ Servicio de Emergencias Pediátricas, Fundación Valle del Lili, Cali, Colombia
• ⁸ Servicio de Neurología Pediátrica, Fundación Valle del Lili, Cali, Colombia
• ⁹ Unidad de Cuidados Intensivos Pediátricos, Fundación Valle del Lili, Cali, Colombia

Objective: This study aims to describe clinical variables and quality care indicators in pediatric stroke management at a high-complexity pediatric care center in Latin America. Methods: Retrospective study of patients with stroke, aged 2-18 years from 2011 to 2021. The principal outcomes were the mRs and mortality. Differences between groups were assessed using Fisher's exact test and the Mann-Whitney U test. We used logistic regression to explore the association between characteristics reported as relevant in literature and mortality. Results: 136 patients included, with a median age of 11 years, 54% were male. 47% were hemorrhagic strokes, followed by ischemic strokes at 39%. One-third of the cases presented in hospital. 51% of the patients had no prior medical history. The most common symptoms were altered consciousness, headache, and hemiparesis. The median door-to-image time was 123 minutes. The most frequent etiologies in ischemic stroke were arteriopathies and cardiac pathology, while vascular malformation and coagulopathies were predominant in hemorrhagic stroke. No patient received reperfusion therapy. At discharge, 48% of patients had a favorable mRs. The mortality rate was 21%. Patients with inhospital stroke have approximately 7.37 times the odds of dying compared to those with out-of-hospital stroke. Patients with hemorrhagic stroke have approximately 7.46 times the odds of dying compared to those with ischemic stroke. Conclusions: Significant gaps exist in the epidemiology and quality indicators of pediatric stroke care compared to adult protocols. Implementing a "Pediatric code stroke" protocol and conducting prospective studies are crucial for improving pediatric stroke care and outcomes.