Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit

Background: A mobile stroke unit (MSU) allows for early delivery for intravenous tissue plasminogen activator (IV-tPA). A proportion of IV-tPA treated patients may turn out to be stroke mimics. We evaluated the rate and complications seen in stroke mimics treated with tPA from our early experience on MSU. Methods: Retrospective review of patients treated with IV-tPA on the MSU from 2014 to 2016. Charts were reviewed for confirmed strokes by imaging (MRI or CT) and hemorrhagic transformation. Stroke mimics were defined as those without imaging evidence of infarction and a final diagnosis which was not suspected to be stroke. Results: Among 62 patients treated with IV-tPA, 14 (28.6%) had a final diagnosis consistent with a stroke mimics. The majority of these occurred in the first year of the MSU program. Most common mimics included conversion disorder (n=5) and seizures (n=5). While the last known well to IV-tPA times were similar, the MSU door-to-needle time was significantly longer in stroke mimics (38 vs 31 minutes, p = 0.03). No intracerebral hemorrhages or other IV-tPA related complications were identified in the stroke mimics group. Conclusions: In our early experience with MSU, treatment of stroke mimics occurred without IV-tPA related complications. This does not appear to be due to rushed decision making.

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Impact of COVID-19 on Stroke Caseload in a Major Hyperacute Stroke Unit

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105383 ◽

2020 ◽

Vol 29 (12) ◽

pp. 105383

Author(s):

Fionn Mag Uidhir ◽

Raj Bathula ◽

Aravinth Sivagnanaratnam ◽

Mudhar Abdul-Saheb ◽

Joseph Devine ◽

...

Keyword(s):

Stroke Unit ◽

Hyperacute Stroke

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Stroke mimic diagnoses presenting to a hyperacute stroke unit

Clinical Medicine ◽

10.7861/clinmedicine.17-1-95a ◽

2017 ◽

Vol 17 (1) ◽

pp. 95.2-96

Author(s):

Oscar MP Jolobe

Keyword(s):

Stroke Unit ◽

Hyperacute Stroke ◽

Stroke Mimic

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Feasibility of a hyper-acute stroke unit model of care across England: a modelling analysis

BMJ Open ◽

10.1136/bmjopen-2017-018143 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018143 ◽

Cited By ~ 7

Author(s):

Michael Allen ◽

Kerry Pearn ◽

Emma Villeneuve ◽

Thomas Monks ◽

Ken Stein ◽

...

Keyword(s):

Acute Stroke ◽

Travel Time ◽

Stroke Unit ◽

Stroke Care ◽

Hyperacute Stroke ◽

Geographical Access ◽

Unit Model ◽

Stroke Services ◽

Time Critical ◽

Institutional Size

ObjectivesThe policy of centralising hyperacute stroke units (HASUs) in England aims to provide stroke care in units that are both large enough to sustain expertise (>600 admissions/year) and dispersed enough to rapidly deliver time-critical treatments (<30 min maximum travel time). Currently, just over half (56%) of patients with stroke access care in such a unit. We sought to model national configurations of HASUs that would optimise both institutional size and geographical access to stroke care, to maximise the population benefit from the centralisation of stroke care.DesignModelling of the effect of the national reconfiguration of stroke services. Optimal solutions were identified using a heuristic genetic algorithm.Setting127 acute stroke services in England, serving a population of 54 million people.Participants238 887 emergency admissions with acute stroke over a 3-year period (2013–2015).InterventionModelled reconfigurations of HASUs optimised for institutional size and geographical access.Main outcome measureTravel distances and times to HASUs, proportion of patients attending a HASU with at least 600 admissions per year, and minimum and maximum HASU admissions.ResultsSolutions were identified with 75–85 HASUs with annual stroke admissions in the range of 600–2000, which achieve up to 82% of patients attending a stroke unit within 30 min estimated travel time (with at least 95% and 98% of the patients being within 45 and 60 min travel time, respectively).ConclusionsThe reconfiguration of hyperacute stroke services in England could lead to all patients being treated in a HASU with between 600 and 2000 admissions per year. However, the proportion of patients within 30 min of a HASU would fall from over 90% to 80%–82%.

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“Mobile Stroke Unit” for Hyperacute Stroke Treatment

Stroke ◽

10.1161/01.str.0000075573.22885.3b ◽

2003 ◽

Vol 34 (6) ◽

Cited By ~ 59

Author(s):

Klaus Fassbender ◽

Silke Walter ◽

Yang Liu ◽

Frank Muehlhauser ◽

Andreas Ragoschke ◽

...

Keyword(s):

Stroke Unit ◽

Stroke Treatment ◽

Hyperacute Stroke ◽

Mobile Stroke Unit

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The Orpington Prognostic Scale: a predictive tool for discharge destination and outcomes in stroke survivors admitted to a hyperacute stroke unit

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2016.12.sup5.s12 ◽

2016 ◽

Vol 12 (Sup5) ◽

pp. S12-S18

Author(s):

Sushmita Mohapatra ◽

Amy Jones

Keyword(s):

Stroke Unit ◽

Stroke Survivors ◽

Discharge Destination ◽

Predictive Tool ◽

Hyperacute Stroke

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A MULTIDISCIPLINARY SIMULATION TRAINING PROGRAMME IN THE HYPERACUTE STROKE UNIT

10.26226/morressier.5ab8f561d462b8029238cf43 ◽

2018 ◽

Author(s):

Adam Seed

Keyword(s):

Stroke Unit ◽

Simulation Training ◽

Training Programme ◽

Hyperacute Stroke ◽

Multidisciplinary Simulation

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Abstract TP386: National Institute of Health Stroke Scale Completion Improved in Hyperacute Stroke Unit; Quality Improvement Strategy for Implementation of the Australian Stroke Foundation 2017 Clinical Guidelines for Stroke Management

Stroke ◽

10.1161/str.51.suppl_1.tp386 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Katherine R Jaques

Keyword(s):

Quality Improvement ◽

Nursing Education ◽

Registered Nurses ◽

Clinical Guidelines ◽

Stroke Unit ◽

Stroke Severity ◽

Stroke Management ◽

Clinical Registry ◽

Quality Improvement Strategy ◽

Hyperacute Stroke

Background and Purpose: In September 2017, a new Hyperacute Stroke Unit (HASU) was opened in a metropolitan hospital with over 400 acute stroke admissions per year, offering endovascular clot retrieval (ECR) and IV thrombolysis; 185 ECR procedures completed in 2018. The HASU opening coincided with publication of the 2017 Australian Clinical Guidelines for Stroke Management. The Guidelines state stroke severity be assessed using a validated tool, such as the National Institute of Health Stroke Scale (NIHSS). A Quality Improvement workshop, March 2018, identified attendance of correct and reliable assessment for stroke severity as a service gap. Goal = Improve NIHSS completion on all stroke patients on presentation to hospital and 24hours post endovascular clot retrieval. This was to be achieved within 90 days of project implementation with the focus on nursing education; a new skill addition to the ward environment. Methods: Education workshops (August-September 18) were implemented with the goal of building knowledge, skills and confidence along with gaining NIHSS certification. All clinical and registered nurses were provided designated time to attend workshops. Workshops were also provided to Medical officers (January 2019) allocated to the Stroke team. Cognitive aids to assist with reducing variability in application of the NIHSS were created. These included NIHSS navigation aids to the electronic medical record, NIHSS app upload to mobile phones, paper based NIHSS assessment to assist the bedside nurses and ward round note templates with auto text for NIHSS completion. Data from three months pre and post implementation was collected and compared using the Australian Stroke Clinical Registry (AuSCR). All patients admitted with stroke were included in this analysis (Jan 18-April 19). Results: NIHSS completion on patient presentation increased by 12% (n=325). NIHSS completion at 24hrs for patients post ECR increased by 22% (n=163). 31 registered nurses trained; 8 medical officers trained. Conclusions: Targeted, multimodal strategies improved completion of NIHSS on presentation and particularly, 24hrs post ECR. Further implementation in the emergency department is required to gain improvements in NIHSS completion on presentation.

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