scholarly journals Imbalanced Regional Development of Acute Ischemic Stroke Care in Emergency Departments in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jianguo Li ◽  
Jingming Liu ◽  
Yuefeng Ma ◽  
Peng Peng ◽  
Xiaojun He ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Regional Development ◽  
Emergency Care ◽  
Regional Differences ◽  
Nationwide Survey ◽  
Stroke Care ◽  
The Status ◽  
The Impact ◽  
Structured Questionnaire

Objective. Most patients of acute ischemic stroke (AIS) receive treatments in the department of emergency in China. We aimed to examine the status of AIS diagnosis and treatment and the impact of green pathway operation in different regions of China. Methods. In this nationwide survey, information regarding the emergency care of AIS was collected from 451 hospitals in different regions of China, by interviewing 484 physicians from these hospitals. Structured questionnaire was used to explore the status of AIS care and impact of the green pathway. Results. 445 hospitals from 18 provinces, 4 municipalities, and 3 ethnic autonomous regions in China were included in the present study. Overall, the proportion of door-to-needle time (DNT) less than 60 min was 66.08% in the enrolled hospitals (n = 298). Stratified by regions, the results suggested that hospitals located in East regions had shorter DNT time (P=0.036), and more proportion of rtPA (P<0.001) than those in West regions. Further analysis suggested that hospitals with a green channel were more likely to shorten DNT and improve the proportion of rtPA (P<0.01). Conclusion. Considerable regional differences were observed in terms of DNT time and thrombolysis rates in the departments of emergency in China. Further studies are required to confirm the regional differences in AIS care in China.

Management of acute ischemic stroke

BMJ ◽  
2020 ◽  
pp. l6983 ◽  
Author(s):  
Michael S Phipps ◽  
Carolyn A Cronin
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Time ◽  
Recurrent Stroke ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Developed Countries ◽  
Future Research ◽  
The Impact

ABSTRACT Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.

scholarly journals Emergency Medicine Pharmacist Impact on Door-to-Needle Time in Patients With Acute Ischemic Stroke

2017 ◽  
Vol 8 (2) ◽  
pp. 60-65 ◽  
Author(s):  
Joshua S. Jacoby ◽  
Heather M. Draper ◽  
Lisa E. Dumkow ◽  
Muhammad U. Farooq ◽  
G. Robert DeYoung ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Length Of Hospital Stay ◽  
Stroke Care ◽  
Neurological Status ◽  
National Institutes Of Health ◽  
Discharge Disposition ◽  
Scale Scores ◽  
The Impact

Background and Purpose: Decreased door-to-needle (DTN) time with tissue plasminogen activator (tPA) for acute ischemic stroke is associated with improved patient outcomes. Emergency medicine pharmacists (EMPs) can expedite the administration of tPA by assessing patients for contraindications, preparing, and administering tPA. The purpose of this study was to determine the impact of EMPs on DTN times and clinical outcomes in patients with acute ischemic stroke who receive tPA in the emergency department. Methods: A retrospective, single-center, cohort study of patients who received tPA between August 1, 2012, and August 30, 2014, was conducted to compare DTN times with or without EMP involvement in stroke care. Secondary outcomes included changes in neurological status as measured by the National Institutes of Health Stroke Scale (NIHSS), length of hospital stay, discharge disposition, symptomatic intracranial hemorrhage, and in-hospital all-cause mortality. Results: A total of 100 patients were included. The EMPs were involved in the care of 49 patients. The EMP involvement was associated with a significant improvement in DTN time (median 46 [interquartile range IQR: 34.5-67] vs 58 [IQR: 45-79] minutes; P = .019) and with receiving tPA within 45 minutes of arrival (49% vs 25%, odds ratio [OR]: 2.81 [95% confidence interval [CI]: 1.21-6.52]). National Institutes of Health Stroke Scale scores were significantly improved at 24 hours post-tPA in favor of the EMP group (median NIHSS 1 [IQR: 0-4] vs 2 [IQR: 1-9.25]; P = .047). Conclusions: The EMP involvement in initial stroke care was associated with a significant improvement in DTN time.

Abstract WP383: An Economic Model of Improved Acute Stroke Care in the Management of Acute Ischemic Stroke From A State Medicaid Perspective

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Zheng-Yi Zhou ◽  
Liangyi Fan ◽  
Er Chen ◽  
Jipan Xie ◽  
Eric Q Wu
Keyword(s):  
Ischemic Stroke ◽  
Nursing Home ◽  
Nursing Homes ◽  
Acute Ischemic Stroke ◽  
Economic Model ◽  
Stroke Care ◽  
The United States ◽  
Absolute Increase ◽  
Medicaid Spending ◽  
The Impact

Background: Stroke is a leading cause of long-term disability in the United States. Approximately one in four stroke survivors is admitted to a nursing home, accounting for a significant portion of Medicaid spending on stroke. Objective: To assess the impact of increasing access to primary stroke centers (PSCs) and implementing an emergency medical services (EMS) system on disability and Medicaid spending on nursing homes for ten geographically representative states. Methods: An economic model was developed to estimate potential reductions in stroke-related disability and corresponding reductions in Medicaid spending on nursing homes among Medicaid enrollees with acute ischemic stroke (AIS), due to improved stroke care infrastructure. The model assessed the increased use of intravenous (IV) thrombolysis as a result of a higher proportion of AIS treated in PSCs, or as a result of integrating an EMS system with PSCs. Based on published literature, more patients received IV thrombolysis in PSCs vs. non-PSCs (6.5 vs. 0.9%) and PSCs with an EMS routing protocol vs local services (10.5 vs. 2.5%). State-specific model inputs included the incidence of first-ever AIS in Medicaid enrollees, nursing home costs, and Medicaid spending on stroke-related care. Results: A 20% absolute increase in the proportion of AIS patients treated at PSCs will lead to 111 to 2004 more patients receiving IV thrombolysis; 9 to 160 fewer patients with disability; and a reduction in Medicaid nursing home spending of $299,442 to $5.6 million per year across the ten states analyzed (Table). The integration of an EMS system with PSCs will lead to 791 to 14,314 more patients receiving IV thrombolysis; 63 to 1145 fewer patients with disability; and a reduction in Medicaid nursing home spending of $2.1 to $40.0 million per year across the ten states (Table). Conclusions: States may achieve substantial savings through legislative policies that improve PSC access and integration of an EMS system with PSCs.

Abstract P887: Lack of Racial, Ethnic, and Sex Disparities in Ischemic Stroke Care Metrics Within a Telestroke Network

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sujan T Reddy ◽  
Tzu-Ching Wu ◽  
Jing Zhang ◽  
Mohammad H Rahbar ◽  
Christy Ankrom ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Missing Values ◽  
Stroke Care ◽  
Vessel Occlusion ◽  
Mt Evaluation ◽  
Sex Disparities ◽  
Get With The Guidelines ◽  
The Impact ◽  
Racial Ethnic

Introduction: Little is known on the impact of telestroke in addressing disparities in acute ischemic stroke care. Methods: We conducted a retrospective review of acute ischemic stroke patients evaluated over our 17-hospital telestroke network in Texas from 2015-2018. Patients were described as Non-Hispanic White (NHW) male or female, Non-Hispanic Black (NHB) male or female, or Hispanic (HIS) male or female. Single imputation using fully conditional specification was conducted to impute missing values in NIHSS (N=103). We compared frequency of tPA and mechanical thrombectomy (MT) utilization, door-to-consultation times, door-to-tPA times, and time-to-transfer for patients who went on to MT evaluation at the hub after having been screened for suspected large vessel occlusion at the spoke. Results: Among 3873 patients (including 1146 NHW male (30%) and 1134 NHW female (29%), 405 NHB male (10%) and 491 NHB female (13%), and 358 HIS male (9%) and 339 HIS female (9%) patients) (Table 1), we did not find any differences in door-to consultation time, door-to-tPA time, time-to-transfer, frequency of tPA administration or incidence of MT utilization (Table 1 & 2). Conclusion: There was a lack of racial, ethnic, and sex disparities in ischemic stroke care metrics within our telestroke network. In order to fully understand how telestroke alleviates disparities in stroke care beyond our single-network review, collaboration among networks is needed to formulate a multicenter telestroke database similar to the Get-With-The Guidelines.

scholarly journals Corrigendum to “Imbalanced Regional Development of Acute Ischemic Stroke Care in Emergency Departments in China”

2019 ◽  
Vol 2019 ◽  
pp. 1-2
Author(s):  
Jianguo Li ◽  
Jingming Liu ◽  
Yuefeng Ma ◽  
Peng Peng ◽  
Xiaojun He ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Regional Development ◽  
Emergency Departments ◽  
Stroke Care

Abstract P354: Assessment of Phased Implementation of a Mobile Stroke Unit for Acute Ischemic Stroke Treatment

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Soraya Sanchez Molero ◽  
Cynthia Diaz ◽  
James Boozan ◽  
Michael F Stiefel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Tissue Type ◽  
Retrospective Case ◽  
Stroke Treatment ◽  
Mobile Stroke Unit ◽  
Significant Difference ◽  
The Impact

Introduction: The timing of administering tissue-type plasminogen activator (tPA) in patients with an ischemic stroke is directly related to clinical outcomes. The use of a mobile stroke unit (MSU) is a strategy to provide acute ischemic stroke assessment and treatment in a more rapid fashion compared to standard stroke transport and management. Our program initiated the use of a MSU in 2017 as a part of a phased implementation program. We sought to determine the impact of the MSU on the timing of stroke care in the region as it related to proximity to the hospital. Methods: We collected data during the first 9 months of 2017 on patients who were transported to the hospital as pre-hospital stroke alerts (PHSA) via conventional ambulance or via the MSU. Using a retrospective case-controlled design we compared process metrics associated with the phased implementation of the MSU with conventional pre-hospital stroke alerts as standard of care (SOC). Results: There was a total of 178 stroke alert patients; 72 in the MSU group and 106 in the PHSA group. 35 patients received tPA, 16 in the MSU, 19 in SOC. There was no significant difference in age, body weight, race, gender, and length of stay in the hospital in the two groups. The time from 911 call to arrival on scene was 12.06 min versus 20.4 min in the PHSA and MSU groups, respectively. Despite a longer time for arrival TPA administration for patients within a 5 miles radius of the hospital was 89 ± 25 mins in the SOC group and 78±12 mins in the MSU group (p=0.11). For 911 calls originating 10-20 miles from the hospital, the time for 911 call to tPA was 106 ± 23 mins in the PHSA group (n = 4) and 86 ± 2 mins in the MSU group (n = 4). Conclusion: Our initial results are comparable with previously reported data . Our data suggests the MSU may have a greater impact on reducing time to tPA for those further from the hospital or where transport time is delayed. The role of the MSU for non tPA patients such as mechanical thrombectomy, intracerebral hemorrhage and subarachnoid hemorrhage warrants further investigation.

The impact of antihypertensive use in the treatment of acute ischemic stroke in patients receiving alteplase

2021 ◽  
Author(s):  
Megan A. Rech ◽  
Elisabeth Donahey ◽  
Joshua M. DeMott ◽  
Laura L. Coles ◽  
Gary D. Peksa
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
The Impact

Integrative physiological assessment of cerebral hemodynamics and metabolism in acute ischemic stroke

2021 ◽  
pp. 0271678X2110337
Author(s):  
Jui-Lin Fan ◽  
Ricardo C Nogueira ◽  
Patrice Brassard ◽  
Caroline A Rickards ◽  
Matthew Page ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cerebral Autoregulation ◽  
Cerebral Perfusion ◽  
Prognostic Markers ◽  
Important Determinant ◽  
Stroke Care ◽  
Contentious Issue ◽  
Ischemic Tissue ◽  
Physiological Assessment

Restoring perfusion to ischemic tissue is the primary goal of acute ischemic stroke care, yet only a small portion of patients receive reperfusion treatment. Since blood pressure (BP) is an important determinant of cerebral perfusion, effective BP management could facilitate reperfusion. But how BP should be managed in very early phase of ischemic stroke remains a contentious issue, due to the lack of clear evidence. Given the complex relationship between BP and cerebral blood flow (CBF)—termed cerebral autoregulation (CA)—bedside monitoring of cerebral perfusion and oxygenation could help guide BP management, thereby improve stroke patient outcome. The aim of INFOMATAS is to ‘ identify novel therapeutic targets for treatment and management in acute ischemic stroke’. In this review, we identify novel physiological parameters which could be used to guide BP management in acute stroke, and explore methodologies for monitoring them at the bedside. We outline the challenges in translating these potential prognostic markers into clinical use.

scholarly journals Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuhong Yu ◽  
Yi Luo ◽  
Tan Zhang ◽  
Chenrong Huang ◽  
Yu Fu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Odds Ratio ◽  
Poor Outcome ◽  
Net Reclassification Improvement ◽  
Potential Biomarker ◽  
The Impact ◽  
The Relationship ◽  
Integrated Discrimination Improvement

Abstract Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001). Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

scholarly journals Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

2021 ◽  
Vol 13 (1) ◽  
pp. 46-58
Author(s):  
João Paulo Branco ◽  
Filipa Rocha ◽  
João Sargento-Freitas ◽  
Gustavo C. Santo ◽  
António Freire ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Observational Study ◽  
Acute Ischemic Stroke ◽  
Upper Limb ◽  
Functional Recovery ◽  
Prospective Observational Study ◽  
Positive Impact ◽  
Rehabilitation Program ◽  
Patient Functioning ◽  
The Impact

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

Sign in / Sign up

Export Citation Format

Share Document