Will Your Stroke Be Treated in Detroit?

P162 Background: rt-PA is the only currently available FDA approved therapy for acute ischemic stroke. We sought to determine the type and frequency of challenges/barriers to offering this therapy 4 years after FDA approval. Methods: We performed a systematic survey in April, 2000 of all 34 hospitals in the Detoit Metropolitan area (population 3.9 million people) that have an acute care emergency facility. A standardized, structured questionnaire/interview was conducted with the directors of the emergency facilities. Questions included: volume of stroke, priority of care given, relationship with Emergency Medical Services (EMS), use of protocols, pathways, and NIH Stroke Scale,time to processes and personnel involved. Surveys were returned, data was tabulated and analyzed descriptively. Results: All 34(100%) of the hospitals responded and wished to participate. While EMS called the Emergency Department(ED) prior to their transport of a suspected stroke patient in 28 centers (82%)only 19 centers (68%) utilized this information to expedite the care of the stroke patient. Stroke patients are given top priority for CT scanning in only 22 centers (64%). The range of times from ED arrival to CT scan performance ranged from 5 minutes to one hour. CT technicians are available 24hrs/day in-house in 56%. In the 44% with on-call, out-of-the hospital CT technicians, time to their arrival ranges from 30–60 minutes. Only a radiologist reads the CT in 18 Hospital, ED physicians review the CT in 15 and only a neurologist in 1. Only 10 (30%) collected data on stroke patients in the ED. Once the patient is considered for treatment with rt-PA, the number of physicians involved in the process varied from 1 to 3. Most commonly involved were a neurologist (22 centers) and ED physicians(at nearly all the centers). Stroke teams were involved at only two hospitals. If more than one physician is involved the average response time is 27 minutes. An NIHSS is performed in 53% of the hospitals. Conclusions: While considerable progress has been made in many Detroit-area hospitals to deliver rt-PA therapy for acute stroke, several key process improvement areas have been identified that could increase the percentage of acute stroke patients treated with rt-PA.

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Timing of Aspirin and Secondary Preventative Therapies in Acute Stroke: Support for Use of Stroke Units

Scottish Medical Journal ◽

10.1177/003693300505000209 ◽

2005 ◽

Vol 50 (2) ◽

pp. 69-72 ◽

Cited By ~ 1

Author(s):

J Reid ◽

M-J MacLeod ◽

D Williams

Keyword(s):

Acute Stroke ◽

Ct Scanning ◽

Medical Ward ◽

Stroke Patients ◽

Stroke Units ◽

General Medical Ward ◽

Brain Scans ◽

Angiotensin Ii Antagonist ◽

Acute Stroke Unit ◽

Ct Brain

Background: We aimed to study the timing of aspirin prescription in ischaemic stroke comparing patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed prescription of secondary preventive therapies in stroke patients in an ASU. Methods: Retrospective analysis was made of medical notes and prescription records of 69 patients admitted to an ASU over a three month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, CT brain scan and route of admission to the ASU. Results: CT brain scans were obtained at a median of 2.1 days post stroke (IQ range 1.3–4.3). Patients directly admitted to the ASU received aspirin earlier post admission compared to those admitted via a medical ward (0.7 vs 2.2 days, p<0.01) and were also more likely to receive aspirin prior to CT scan being performed (57% vs 19%, p=0.02). 86% of stroke patients were discharged on an antiplatelet therapy, 79% on a statin, 37% on a thiazide diuretic and 32% on an ACE inhibitor or angiotensin II antagonist. Conclusion: Aspirin was given more promptly in acute stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in stroke but there is a much lower rate of initiation of other secondary preventive therapies (e.g. anti-hypertensive therapy) in hospital. These findings demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units.

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Pharmacists as Care Providers for Stroke Patients: A Systematic Review

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.233 ◽

2017 ◽

Vol 45 (1) ◽

pp. 49-55 ◽

Cited By ~ 7

Author(s):

Jade E. Basaraba ◽

Michelle Picard ◽

Kirsten George-Phillips ◽

Tania Mysak

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Acute Stroke ◽

Patient Care ◽

Patient Outcomes ◽

Stroke Patient ◽

Full Text ◽

Stroke Patients ◽

Pharmacist Interventions ◽

The Impact

AbstractBackground:Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes.Methods: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed.Results: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life.Conclusions: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

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Abstract W P187: Utilization of Emergency Medical Services to Transfer Acute Stroke Patients Directly to Scanning Reduces the Length of Time to Scan Result

Stroke ◽

10.1161/str.45.suppl_1.wp187 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Scott Dunbar ◽

Theresa Hoffecker ◽

Avery Schwenk

Keyword(s):

Acute Stroke ◽

Ct Scan ◽

Emergency Medical Services ◽

Ct Scanning ◽

Medical Services ◽

Time Of Arrival ◽

Stroke Patients ◽

Emergency Medical ◽

Number Of Patients ◽

The Mean

Background: Rapid assessment and treatment of acute stroke patients including computerized tomography (CT) scanning to determine the need for tissue plasminogen activator (tPA) has been shown to be vital to positive patient outcomes. As part of an ongoing effort to reduce door-to-needle time for such patients, the door-to-CT result time was identified as an area that could be reduced by collaborative effort between Emergency Medical Services (EMS) and Emergency Department (ED) staff. We hypothesized that implementing an EMS protocol for direct-to-CT scanning as part of a collaborative stroke alert protocol would reduce overall door-to-CT result time. Methods: Local EMS and ED implemented criteria to alert the ED of acute stroke patients being transported to their facility. This alert included an estimated time of arrival and was sent to radiology, neurology, registration and pharmacy. Upon arrival, the patient was met by ED personnel while still on the EMS gurney. If the ED physician concurred with the field impression of acute stroke, the patient was taken directly to CT scanning by EMS. Data on time of door-to-CT result were collected from 7/9/12 to 7/8/13 and divided into those patients who received a stroke alert from EMS (n=41), and those who did not (n=81). All data are expressed as mean ± standard error. Results: The time for door-to-CT result was reduced (p<0.0001) for patients who received a stroke alert from EMS [16.5 ± 1.2 vs 31.6 ± 1.5 minutes, alert vs no alert, respectively]. Similarly, in the subset of patients who received tPA after the CT scan, the mean time door-to-CT scan results was reduced (p<0.005) in those patients who received a stroke alert from EMS (14.3 ± 1.1 vs 36.4 ± 7.3 minutes, alert vs no alert, respectively). Conclusions: Implementation of a stroke alert including a direct-to-CT protocol by EMS significantly reduced the mean door-to-CT result time in acute stroke patients. Expanding this protocol to include other area EMS services and hospitals could potentially result in a greater number of patients benefiting from these reduced times.

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Abstract WP274: Improving Door to Ct Time by a Seven Item Stroke Screening Questionnaire for Patients Arriving to ER with Acute Stroke without Prior Notification

Stroke ◽

10.1161/str.48.suppl_1.wp274 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Roni Eichel ◽

Penina Ponger ◽

Nechama Kaufmann ◽

Natan M Bornstein

Keyword(s):

Acute Stroke ◽

Median Time ◽

Screening Method ◽

Triage Nurse ◽

Stroke Patients ◽

Early Screening ◽

Time Intervals ◽

Screening Questionnaire ◽

Prior Notification ◽

Suspected Stroke

Background: Arrival to the emergency room (ER) by ambulance services and prior notification have been identified as major factors for reducing Door to CT and Door to needle time with thrombolysis for patients with acute stroke. Unfortunately despite all efforts to increase the awareness of using ambulances, still 40-50% of patients arrive by private transportation without prior notification of the ER. Objective: We evaluated if a standardized seven item screening questionnaire, performed at the admission office of the ER, can reduce time to triage nurse evaluation and subsequently time of arrival to CT, for patients with acute stroke arriving to the ER without prenotification of the ER. Methods: Since April 2016 a standardized screening questionnaire was performed by the admission clerks at the ER arrival for any patient not referred by prior notification for stroke. This questionnaire included seven major stroke symptoms and time of onset of the symptoms. If one of these symptoms started less than 8 hours before the arrival to the ER the patient was urgently referred to the triage nurse which would then evaluate urgently and activate the a Stroke Code. Patient data was collected of all patients admitted to the ER with a suspected stroke between April-June 2015 and April-June 2016 and time intervals for Door to triage nurse and Door to CT were compared for patients admitted to the ER with suspected Stroke between the time period without questionnaire and with. Results: In the relevant time periods 143 stroke patients were admitted to our ER. Median time from arrival to triage nurse was 16 min (n=96) in 2016 compared to 28 min (n=47) in 2015 (p>0.0001). Patients arriving within 8 hours form symptom onset the median time for arrival to triage nurse was 15 min (n=49) and 28min (n=14) respectively (p=0.006). Median time from arrival to ER to CT brain was 29 min(n=18) for the group that was screened by an early seven point questionnaire at ER admission and stroke code activated versus 78 min(n=14)without early screening and stroke code activation(p=0.069). Conclusion: A standardized seven item stroke symptom questionnaire as an early ER admission screening method can reduce time intervals from arrival to CT for self-referral stroke patients without prior notification of the ER.

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Ambulance service call handler and clinician identification of stroke in North East Ambulance Service

British Paramedic Journal ◽

10.29045/14784726.2021.09.6.2.59 ◽

2021 ◽

Vol 6 (2) ◽

pp. 59-65

Author(s):

Graham McClelland ◽

Emma Burrow

Keyword(s):

Acute Stroke ◽

Early Recognition ◽

Stroke Care ◽

Service Evaluation ◽

Ambulance Service ◽

Stroke Patients ◽

Face To Face ◽

North East ◽

Audit Data ◽

Suspected Stroke

Introduction: Emergency medical services (EMS) are the first point of contact for most acute stroke patients. The EMS response is triggered by ambulance call handlers who triage calls and then an appropriate response is allocated. Early recognition of stroke is vital to minimise the call to hospital time as the availability and effectiveness of reperfusion therapies are time dependent. Minimising the pre-hospital phase by accurate call handler stroke identification, short EMS on-scene times and rapid access to specialist stroke care is vital. The aims of this study were to evaluate stroke identification by call handlers and clinicians in North East Ambulance Service (NEAS) and report on-scene times for suspected stroke patients.Methods: A retrospective service evaluation was conducted linking routinely collected data between 1 and 30 November 2019 from three sources: NEAS Emergency Operations Centre; NEAS clinicians; and hospital stroke diagnoses.Results: The datasets were linked resulting in 2214 individual cases. Call handler identification of acute stroke was 51.5% (95% CI 45.3‐57.8) sensitive with a positive predictive value (PPV) of 12.8% (95% CI 11.4‐14.4). Face-to-face clinician identification of stroke was 76.1% (95% CI 70.4‐81.1) sensitive with a PPV of 27.4% (95% CI 25.3‐29.7). The median on-scene time was 33 (IQR 25‐43) minutes, with call handler and clinician identification of stroke resulting in shorter times.Conclusion: This service evaluation using ambulance data linked with national audit data showed that the sensitivity of NEAS call handler and clinician identification of stroke are similar to figures published on other systems but the PPV of call handler and clinician identification stroke could be improved. However, sensitivity is paramount while timely identification of suspected stroke patients and rapid transport to definitive care are the primary functions of EMS. Call handler identification of stroke appears to affect the time that clinicians spend at scene with suspected stroke patients.

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The Maryland Acute Stroke Emergency Medical Services Routing Pilot: Expediting Access to Thrombectomy for Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.663472 ◽

2021 ◽

Vol 12 ◽

Author(s):

Taylor Haight ◽

Burton Tabaac ◽

Kelly-Ann Patrice ◽

Michael S. Phipps ◽

Jaime Butler ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Emergency Medical Services ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Emergency Medical ◽

Suspected Stroke

Background: Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke caused by large vessel occlusion, but is not available at all stroke centers. Transfers between hospitals lead to treatment delays. Transport directly to a facility capable of MT based on a prehospital stroke severity scale score has been recommended, if transportation time is less than 30 min.Aims: We hypothesized that an Emergency Medical Services (EMS) routing algorithm for stroke, using the Los Angeles Motor Scale (LAMS) in the field, would improve time from last known well to MT, without causing patients to miss the IV Thrombolysis (IVT) window.Methods: An EMS algorithm in the Baltimore metro area using the LAMS was implemented. Patients suspected of having an acute stroke were assessed by EMS using the LAMS. Patients scoring 4 or higher and within 20 h from last known well, were transported directly to a Thrombectomy Center, if transport could be completed within 30 min. The algorithm was evaluated retrospectively with prospectively collected data at the Thrombectomy Centers. The primary outcome variables were proportion of patients with suspected stroke rerouted by EMS, proportion of rerouted ischemic stroke patients receiving MT, time to treatment, and whether the IVT window was missed.Results: A total of 303 patients were rerouted out of 2459 suspected stroke patients over a period of 6 months. Of diverted patients, 47% had acute ischemic stroke. Of these, 48% received an acute stroke treatment: 16.8% IVT, 17.5% MT, and 14% MT+IVT. Thrombectomy occurred 119 min earlier in diverted patients compared to patients transferred from other hospitals (P = 0.006). 55.3% of diverted patients undergoing MT and 38.2% of patients transferred from hospital to hospital were independent at 90 days (modified Rankin score 0–2) (P = 0.148). No patient missed the time window for IVT due to the extra travel time.Conclusions: In this retrospective analysis of prospectively acquired data, implementation of a pre-hospital clinical screening score to detect patients with suspected acute ischemic stroke due to large vessel occlusion was feasible. Rerouting patients directly to a Thrombectomy Center, based on the EMS algorithm, led to a shorter time to thrombectomy.

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Abstract T P261: Non-Contrast Head CT Prior to Comprehensive Neurological Evaluation Reduces Door to Needle Times for Administration of Intravenous rtPA

Stroke ◽

10.1161/str.45.suppl_1.tp261 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lesia Mooney ◽

Suzanne Shaw ◽

Kevin Barrett ◽

Carol Raper

Keyword(s):

Emergency Department ◽

Ct Scanning ◽

Ct Scanner ◽

Clinical Workflow ◽

Stroke Patients ◽

Head Ct ◽

Emergency Department Arrival ◽

Neurological Evaluation ◽

Exam Room ◽

Suspected Stroke

Background: American Heart Association/American Stroke Association recommends treatment of eligible acute ischemic stroke patients with intravenous rtPA <60 minutes from emergency department arrival. Purpose: A quality improvement project was designed to reduce the door to needle times for intravenous rtPA administration at Mayo Clinic Florida. We hypothesized that workflow changes in emergency department evaluation of suspected stroke patients would decrease door to needle times. The goal was to treat >75% of patients eligible for IV t-PA within 60 minutes of ED arrival. Methods: We utilized LEAN methods to develop a project charter, identify stakeholders, and visually map the emergency department clinical workflow. Prior to project initiation, suspected stroke patients were taken upon arrival to an exam room for clinical evaluation followed by transport to the CT scanner and return to the exam room for decision-making and rtPA administration. The clinical workflow was changed to obtain patient weight immediately upon arrival, abbreviated patient assessment and lab draws outside of the CT scanner in a holding bay and performing CT scanning prior to transport to an examination room for decision making and rtPA administration. Results: In a 12 month period preceding project initiation, 29 patients were treated with rtPA, 55 % were treated <60 minutes of emergency department arrival. In the 11 month period following implementation of CT scanning prior to neurological evaluation, 57 patients were treated with rtPA, 80 % were treated in <60 minutes of emergency department arrival. The mean door to needle time was reduced from 66 minutes to 46 minutes following the clinical workflow change. No patients experienced clinical deterioration at the time of CT scanning. Conclusions: Non-contrast head CT scan be safely performed prior to comprehensive neurological evaluation and reduces door-to-needle times for intravenous rtPA administration in eligible stroke patients. Validated process improvement paradigms such as LEAN have the potential to reduce door to needle times and improve patient outcomes.

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Abstract WP279: Concordance of Paramedic and Hospital Documented Last Known Well Times for EMS Transported Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.wp279 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lucas Ramirez ◽

Nichole Bosson ◽

Marianne Gausche-Hill ◽

Jeffery L Saver ◽

Sid Starkman ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Patient Characteristics ◽

Final Diagnosis ◽

Multivariate Regression Analysis ◽

Stroke Patients ◽

Hospital Arrival ◽

Median Difference ◽

Suspected Stroke ◽

Stroke Center

Background: Last known well time (LKWT) is increasingly used by EMS systems to identify acute stroke patients appropriate for direct routing to Stroke Centers. However, determining LKWT in the field is challenging, as patients may be aphasic, witnesses may not be available on scene, and rapid departure from the scene is desirable. Objective: To characterize the concordance and degree of discordance between prehospital-determined LKWT and final LKWT documented at the hospital. Methods: This is a retrospective analysis of consecutive patients with positive prehospital stroke screens transported to an approved stroke center in a large metropolitan system from January 2011 to December 2014. Data was abstracted from the regional EMS Agency stroke database. Patients with missing prehospital or hospital documentation of LKWT were excluded. The percent concordance and the median difference were calculated for prehospital versus final hospital documented LKWT. The effect of patient characteristics on discordance was also explored via multivariate regression analysis. Result: Among the 9,810 patients transported for suspected stroke, the median age was 75 (Interquartile range [IQR] 62-85) years, 53% were women, 67% White, 11% Asian, 9% Black and 27% Hispanic. The median NIHSS was 11 (IQR 4 to 20). 83% had a cerebrovascular final diagnosis, ischemic stroke (IS) being the most common (n=5160, 53%), whereas 17% had a non-stroke-related diagnosis. There were 6873 patients missing either prehospital or hospital documentation of LKWT leaving 9810 patients for the analysis. Prehospital and hospital documented LKWTs were exactly equal in 42% of patients (36% for IS), within 15 minutes in 53% (48% for IS), within 1 hour in 66% (63% in IS) and within 2 hours in 70% (68% in IS). The median difference in LKWT between documented prehospital and hospital values was 0 minutes (IQR -6 to 18). The degree of discordance in LKWT did not vary with patient sex, race, or Hispanic ethnicity. Conclusions: Paramedic-documented LKWT was within 15 minutes of the final hospital documented LKWT in just over half of acute stroke EMS transports and within 1 hour in two-thirds.. As accurate LKWT determination in the field is challenging, time of symptom onset should be confirmed after hospital arrival.

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PP11 The use of prehospital 12-lead electrocardiograms in acute stroke patients

Emergency Medicine Journal ◽

10.1136/emermed-2019-999.11 ◽

2019 ◽

Vol 36 (1) ◽

pp. e5.1-e5

Author(s):

Scott Munro ◽

Debbie Cooke ◽

Mark Joy ◽

Adam Smith ◽

Kurtis Poole ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Stroke ◽

Secondary Analysis ◽

Vital Role ◽

Current Guideline ◽

Hospital Data ◽

Stroke Patients ◽

Time Intervals ◽

Suspected Stroke ◽

Clinical Records

BackgroundEmergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke, but this recommendation is based on expert consensus, rather than robust evidence.The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received.MethodsA multicentre retrospective cohort study was undertaken.The data collection period spanned from 29/12/2013–30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number.ResultsPHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.30, 95% CI 1.01 to 1.66, p=0.04) and in-hospital mortality (aOR 1.83, 95% CI 1.26–2.67, p=0.002). There was no association between PHECG and administration of thrombolysis (aOR 1.06, 95% CI 0.75–1.52, p=0.73).Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.32) or median door-to-needle time (median 46 min vs 48 min, p=0.37) were observed.ConclusionThis is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke.

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Dyselectrolytaemia in Acute Stroke Patients, an Observational Study

Bangladesh Journal of Medicine ◽

10.3329/bjmed.v22i2.13586 ◽

2013 ◽

Vol 22 (2) ◽

pp. 30-34 ◽

Cited By ~ 1

Author(s):

MR Siddiqui ◽

QT Islam ◽

MA Haque ◽

MJ Iqbal ◽

A Hossain ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Stroke Patient ◽

Haemorrhagic Stroke ◽

Age Group ◽

Acute Stroke Patient ◽

Stroke Patients ◽

College Hospital ◽

Medical College ◽

Associated Conditions

Background: There are many studies on stroke, its associated conditions and their effect on stroke patients outcome, but a few studies on dyselectrolytaemia in stroke patients has been done in our country, even outside. Method: a total number of 100 randomly selected, clinically and CT proven acute stroke patients were studied at medicine units of Dhaka Medical College Hospital. Association of electrolytes imbalance among acute stroke patient were identified and correlated. Result: Out of 100 patients 29% were in between 51-60 years age group & 72% were male and 28% were female patients. Majority 53% patients had Ischaemic stroke, 45% Intracerebral haemorrhage (ICH) and only 2% had Subarachnoid haemorrhage (SAH). 53% of total acute stroke patient had dyselectrolytaemia. Among 100 acute stroke patients 62.22% of haemorrhagic stroke (p<0.05) & 43.39% of ischaemic stroke (p>0.05) patients had dyselectrolytaemia. Total 36% of all stroke patients had serum sodium imbalance & 31% had serum potassium imbalance. In haemorrhagic stroke & ischaemic stroke patients, hyponatraemia (17% & 13%), hypernatraemia (1% & 3%), hypokalaemia (19% & 11%), hyperkalaemia (0% & 1%), hypochloraemia (9% & 6%) respectively with found. Conclusion: In haemorrhagic stroke, the incidence of dyselectrolytaemia was more than ischaemic stroke and which were mostly hyponatraemia and hypokalaemia. DOI: http://dx.doi.org/10.3329/bjmed.v22i2.13586 Bangladesh J Medicine 2011; 22: 30-34

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