Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review

2019 ◽  
Vol 73 (2) ◽  
pp. 118-129
Author(s):  
Hadi Hassankhani ◽  
Amin Soheili ◽  
Samad S. Vahdati ◽  
Farough A. Mozaffari ◽  
Justin F. Fraser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Delays

Abstract P176: Improving Door to Needle Times With CT Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sarah Jamieson ◽  
Alexandra C Lesko ◽  
Elizabeth Baraban ◽  
Lisa R Yanase
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Chart Review ◽  
Group Analysis ◽  
Retrospective Chart Review ◽  
Inclusion Criteria ◽  
Night Time ◽  
Intention To Treat ◽  
The Difference ◽  
Treat Analysis

Introduction: Thrombolytic treatment of acute ischemic stroke (AIS) during night-time hours and weekends is associated with prolonged door to needle (DTN) times. A CT suite telestroke unit (CTTU) was installed at two urban stroke centers to expedite treatment for AIS patients. The purpose of this study was to determine whether CTTU evaluation would decrease DTN times on nights and weekends. Methods: A retrospective chart review included patients 18 years and older presenting with AIS to the emergency department and treated with IV alteplase on a week-night (4pm-8am) or weekend (Friday 4pm - Monday 8am) between January 2019- February 2020. The distribution of median DTN times were compared for the following groups: (1) Pre-CTTU installation (January 1, 2019-July 28, 2019) versus post-CTTU installation (July 29, 2019 - February 29, 2020), regardless of telestroke usage (“intention to treat”), (2) Pre-CTTU (using traditional telestroke and excluding bedside evaluations) versus post-CTTU (using CTTU and excluding bedside evaluations) (“per-protocol”) and (3) Post-CTTU period use of traditional telestroke versus CTTU (“post-CTTU group”). Analyses were performed using the Mann-Whitney U test. Results: A total of 111 patients met inclusion criteria with 44 (39.6%) treated in the pre-CTTU period and 67 (60.4%) treated in the post-CTTU period. After installation, CTTU was utilized in 38.8% (n=26) of cases, traditional telestroke in 44.8% (n=30), and the remaining 16.4% (n=11) were evaluated at bedside. The intention-to-treat analysis showed no difference between the pre-CTTU and post-CTTU groups (44.0 minutes vs 44.0 minutes, p=0.909). The per-protocol analysis showed faster DTN times in the Post-CTTU group compared to the Pre-CTTU group (38.5 minutes vs 44.0 minutes, p=0.128), but the difference was not significant. The post-CTTU group analysis showed median DTN times significantly improved using CTTU compared to traditional telestroke (38.5 minutes vs 48.0 minutes, p=0.011). Conclusion: The use of CT telestroke in the evaluation of acute ischemic stroke patients decreased DTN time when a stroke neurologist is not on-site.

scholarly journals Detection of Early Ischemic Changes in Noncontrast CT Head Improved with “Stroke Windows”

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Shraddha Mainali ◽  
Mervat Wahba ◽  
Lucas Elijovich
Keyword(s):  
Ischemic Stroke ◽  
Basal Ganglia ◽  
Acute Ischemic Stroke ◽  
Basilar Artery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Image Evaluation ◽  
Head Ct ◽  
Noncontrast Ct ◽  
Ct Head

Introduction. Noncontrast head CT (NCCT) is the standard radiologic test for patients presenting with acute stroke. Early ischemic changes (EIC) are often overlooked on initial NCCT. We determine the sensitivity and specificity of improved EIC detection by a standardized method of image evaluation (Stroke Windows). Methods. We performed a retrospective chart review to identify patients with acute ischemic stroke who had NCCT at presentation. EIC was defined by the presence of hyperdense MCA/basilar artery sign; sulcal effacement; basal ganglia/subcortical hypodensity; and loss of cortical gray-white differentiation. NCCT was reviewed with standard window settings and with specialized Stroke Windows. Results. Fifty patients (42% females, 58% males) with a mean NIHSS of 13.4 were identified. EIC was detected in 9 patients with standard windows, while EIC was detected using Stroke Windows in 35 patients (18% versus 70%; P<0.0001). Hyperdense MCA sign was the most commonly reported EIC; it was better detected with Stroke Windows (14% and 36%; P<0.0198). Detection of the remaining EIC also improved with Stroke Windows (6% and 46%; P<0.0001). Conclusions. Detection of EIC has important implications in diagnosis and treatment of acute ischemic stroke. Utilization of Stroke Windows significantly improved detection of EIC.

CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

2015 ◽  
Vol 8 (6) ◽  
pp. 559-562 ◽  
Author(s):  
Lucas Elijovich ◽  
Nitin Goyal ◽  
Shraddha Mainali ◽  
Dan Hoit ◽  
Adam S Arthur ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Infarct Volume ◽  
Retrospective Chart Review ◽  
Favorable Outcome ◽  
Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

scholarly journals Quantifying candidate volume for endovascular therapy for acute ischemic stroke: a retrospective chart review

CMAJ Open ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. E671-E677
Author(s):  
Brian Lauzon ◽  
Catherine Corrigan-Lauzon ◽  
Jonathan Grynspan ◽  
Susan Bursey ◽  
Timo Krings ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Chart Review ◽  
Retrospective Chart Review

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

scholarly journals Emergency medical dispatchers’ ability to identify large vessel occlusion stroke during emergency calls

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Pauli E. T. Vuorinen ◽  
Jyrki P. J. Ollikainen ◽  
Pasi A. Ketola ◽  
Riikka-Liisa K. Vuorinen ◽  
Piritta A. Setälä ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Emergency Call ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Emergency Response System ◽  
Emergency Medical ◽  
Cortical Ischemia

Abstract Background In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). We aimed to determine if an emergency dispatcher can recognise LVO stroke during an emergency call by asking the caller a binary question regarding whether the patient’s head or gaze is away from the side of the hemiparesis or not. Further, we investigated if the paramedics can confirm this sign at the scene. In the group of positive CED answers to the emergency dispatcher, we investigated what diagnoses these patients received at the emergency department (ED). Among all patients brought to ED and subsequently treated with mechanical thrombectomy (MT) we tracked the proportion of patients with a positive CED answer during the emergency call. Methods We collected data on all stroke dispatches in the city of Tampere, Finland, from 13 February 2019 to 31 October 2020. We then reviewed all patient records from cases where the dispatcher had marked ‘yes’ to the question regarding patient CED in the computer-aided emergency response system. We also viewed all emergency department admissions to see how many patients in total were treated with MT during the period studied. Results Out of 1913 dispatches, we found 81 cases (4%) in which the caller had verified CED during the emergency call. Twenty-four of these patients were diagnosed with acute ischemic stroke. Paramedics confirmed CED in only 9 (11%) of these 81 patients. Two patients with positive CED answers during the emergency call and 19 other patients brought to the emergency department were treated with MT. Conclusion A small minority of stroke dispatches include a positive answer to the CED question but paramedics rarely confirm the emergency medical dispatcher’s suspicion of CED as a sign of LVO. Few patients in need of MT can be found this way. Stroke dispatch protocol with a CED question needs intensive implementation.

Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Time Of Day ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
The Impact ◽  
Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

scholarly journals Emergency Department Adherence to American Heart Association Guidelines for Blood Pressure Management in Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (2) ◽  
pp. 557-559 ◽  
Author(s):  
Erin McDonough Grise ◽  
Opeolu Adeoye ◽  
Christopher Lindsell ◽  
Kathleen Alwell ◽  
Charles Moomaw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Pressure Management ◽  
Blood Pressure Management

scholarly journals The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Amyna Husain ◽  
M. Douglas Baker ◽  
Mark C. Bisanzo ◽  
Martha W. Stevens
Keyword(s):  
Emergency Department ◽  
Tooth Extraction ◽  
Chart Review ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cultural Practice ◽  
Fluid Bolus ◽  
Significant Difference ◽  
To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

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