scholarly journals Eligibility for intravenous thrombolysis in acute stroke: A multicenter prospective study

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 372-372
Author(s):  
Enrique Mostacero ◽  
Sonia Santos ◽  
Antonio Davalos ◽  
Alberto Gil-Peralta ◽  
Jose Castillo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Acute Stroke ◽  
Life Support ◽  
Advanced Life Support ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Street Hospital ◽  
Modifiable Factors ◽  
Dispatch System

P182 Objective: To elucidate the proportion of patients who would have been eligible for alteplase treatment following the ECASS II criteria in a prospective study conducted in 20 Spanish general or university hospitals. Methods: The first 100 consecutive patients with an acute stroke admitted between 9/98 and 4/99 in each participating hospital were evaluated. Data concerning exclusion criteria for tPA, demographic variables, distance to hospital (<5km,5–20km,>20km), time (0–6am,6–12,12–6pm,6–12pm) and place (home, work/street, hospital) of symptoms onset, subject detecting the event (victim, family member, bystander), dispatch system (own initiative, EMS, primary physician, community hospital), delay and type of transport (own transport, basic, or advanced life support ambulance), cardiovascular risk factors, stroke severity (Canadian scale) and type of stroke were recorded. Results: Out of 1599 screened patients, 166 (10.4%) fulfilled all criteria for tPA treatment. Multiple reasons for exclusion were time from onset >6h in 23%, or unknown in 23%, delay in neurological attention >6h in 39%, TC not available within 6h from onset in 34%, hemorrhage in 14%, early signs of infarction involving >33% MCA in 8%, TIA or rapidly improving symptoms in 24%, coma or hemiplegia plus forced eye deviation in 5%, hypertension >185/110 in 2%, coagulation abnormalities in 1%, and other reasons in 6%. Univariate analyses showed that high eligibility for tPA was associated with type of the first medical intervention (emergency medical system)(p=0.006), type of transport (basic or advanced life support ambulance)(p<0.0001), stroke severity (p<0.001), and type of stroke (cardioembolic) (p=0.0027). Age, distance to hospital, time and place of stroke onset, subject detecting the event, and risk factors were not significantly related to eligibility. Conclusions: Candidates for intravenous tPA treatment within 6 hours from stroke onset are 10% of patients admitted in general hospitals of an EU country. Delay in neurologic attention and CT examination were the main reasons for exclusion. Dispatch system, and type of transport were modifiable factors related to eligibility.

scholarly journals Sex differences in risk factors, treatment, and prognosis in acute stroke

2020 ◽  
Vol 16 ◽  
pp. 174550652095203
Author(s):  
Solveig Dahl ◽  
Clara Hjalmarsson ◽  
Björn Andersson
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Acute Stroke ◽  
Functional Outcome ◽  
Independent Living ◽  
University Hospital ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Study Population

Objectives: Stroke is a major cause of long-term disability and death worldwide. Several studies have shown that women in general have more severe symptoms at arrival to hospital and are less likely to return home and independent living. Our aim with the present study was to update previous results concerning sex differences in baseline characteristics, stroke management, and outcome in a population study from Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: This study included patients with acute ischemic and hemorrhagic stroke in 2014 at Sahlgrenska University Hospital. All data were collected from The Swedish National Stroke Registry (Riksstroke). Results: The study population consisted of 1453 patients, with 46.7% females. Women were 5 years older than men. There was no sex difference in acute stroke severity. Frequency of revascularization was equal between men and women. The stroke mortality rate was the same between the sexes. At 3-months follow-up, women had a worse functional outcome and a higher frequency of depression and post-stroke fatigue. Conclusion: Our results show that there are no sex differences in management of acute stroke. However, the cause of worse functional outcome in women at 3-months follow-up, independent of other risk factors, is not clear and warrants further investigations.

scholarly journals Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung

2021 ◽  
Vol 10 (3) ◽  
pp. 151-161
Author(s):  
Novi Fatni Muhafidzah ◽  
◽  
Sobaryati Mansur ◽  
Emmy Hermiyanti Pranggono ◽  
Yusuf Wibisono ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infarct Size ◽  
Acute Stroke ◽  
Primary Data ◽  
Neurogenic Pulmonary Edema ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Large Infarct

Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital Bandung Abstract Background and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung. Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria. Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia. Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

scholarly journals Prognosis and Associated Factors among Elderly Patients with Small Artery Occlusion

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yuguang Zhao ◽  
Chunxiao Yang ◽  
Xiaobo Yan ◽  
Xu Ma ◽  
Xiaokun Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Triglyceride Level ◽  
Protective Factor ◽  
Artery Occlusion ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Small Artery ◽  
Elevated Triglyceride Level ◽  
Small Artery Occlusion

Abstract Small artery occlusion (SAO) is the one of the primary subtype of ischemic stroke in China. However, its outcomes among elderly patients are unclear. Consecutive patients with SAO were recruited at Jiamusi University First Hospital, China between January 2008 and December 2016. Stroke subtype, severity, and risk factors were collected; outcomes at 3, 12, and 36 months after stroke onset were assessed. A total of 1464 SAO patients were included in this study. Participants aged ≥75 years had higher dependency rates than Participants aged <75 years with SAO in all three follow-up periods, in addition to a higher recurrence rate at 12 months and a higher mortality rate 36 months after stroke. After adjusting for confounders, elevated triglyceride level was found to be a protective factor against mortality 36 months after stroke. Stroke severity, diabetes mellitus, artery stenosis, gender, obesity, and high-density lipoprotein cholesterol level were independently associated with the risk of dependency; elevated triglyceride level was an independent risk factor for recurrence at 3 months point after stroke onset. These findings suggest that it is vital to manage risk factors that may affect prognosis of stroke among elderly patients with SAO to improve patient prognosis and reduce the burden of stroke in China.

Abstract 2634: A Prospective Study Of Asymptomatic Intracranial Arterial Stenosis In Japanese Healthy Subjects

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ryukichi Matsui ◽  
Hiroaki Oguro ◽  
Nagai Atsushi ◽  
Hirokazu Bokura ◽  
Keiichi Onoda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Healthy Subjects ◽  
Significant Risk ◽  
Stroke Onset ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
A Prospective Study ◽  
Age And Sex

Background and purpose: Atherosclerotic stenosis of major intracranial arteries accounts for 5 to 10% of all causes of stroke. The Warfarin versus Aspirin Symptomatic Intracranial Disease (WASID) Study has demonstrated stroke onset in 5 among 100 patients with asymptomatic intracranial arterial stenosis (AIAS) during the follow-up period of 1.8 years. However, there are no prospective studies of intracranial stenosis in healthy subjects with a longer follow-up period. We conducted a 7-years longitudinal study in healthy subjects with AIAS to examine its risk factors and prognosis. Methods: We performed a prospective study on 3,155 neurologically normal subjects without history of stroke (1724 men, 1431 woman, mean age of 59). They were followed up with the mean interval of 83 months to obtain information about their stroke event with a questionnaire by mail or telephone interview and inquiry to the relevant medical facilities. AIAS were assessed on MRA at the time of first visit for all subjects. Result: AIAS was detected in 323 subjects (10.2%; AIAS group) at the initial examination. Significant risk factors for AIAS were older age, female, hypertension, high values of fasting blood glucose and HbA1c. During the follow-up stroke occurred in 77 subjects (2.7%) from the no-AIAS group and 14 subjects (4.3%) from the AIAS group (p = 0.07). Age and sex affected the stroke onset. The Cox's proportional-Hazards regression model after adjustment of age and sex revealed the significant contribution of AIAS on stroke onset (OR 1.9; 95% CI 1.03-3.4, p = 0.039). The stroke types were 11 ischemic and 3 hemorrhagic in the AIAS group. Conclusions: AIAS is a significant risk factor for future stroke even in healthy subjects. Intense management of blood pressure and glucose level might be crucial for preventing asymptomatic intracranial atherosclerotic disease.

Abstract TMP63: Door-In-Door-Out Process Times at 5 Primary Stroke Centers in Chicago

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shyam Prabhakaran ◽  
Rebeca Khorzad ◽  
Zahra Parnianpour ◽  
Christopher T Richards ◽  
William Meurer ◽  
...  
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Linear Regression ◽  
Acute Stroke ◽  
Life Support ◽  
Advanced Life Support ◽  
Ongoing Study ◽  
Mode Of Transport

Introduction: Many patients with acute stroke require inter-facility transfer from primary stroke centers (PSC) to comprehensive stroke centers. Given the time-sensitive benefits of endovascular treatments, door-in-door-out (DIDO) time at the PSC is a target for quality improvement. Methods: As part of a funded ongoing study of redesigning the acute stroke DIDO process, we collected data on consecutive patients with acute stroke between February 2018 and February 2019 who required inter-facility transfer from 5 PSCs to one of 3 CSCs in the Chicago region. The stroke coordinators at each site abstracted data on mode of transport (critical care vs. advanced life support [ALS]), medical events and treatments (intubation, intravenous medications including tPA), times from arrival to: triage, telestroke activation and start, CT and CTA start, initial transfer center contact, ambulance request, and ambulance arrival and departure times. We evaluated predictors of DIDO time using linear regression. Results: Among 107 patients who met study criteria, 67.6% arrived by EMS, 83.2% had telestroke evaluation, 34.6% had tPA treatment, and 43.9% underwent CTA at the PSC. The median DIDO time was 146 (IQR 99-220) minutes. The largest contributors to DIDO time (Figure) were CT to CTA time (45 [18-86] minutes), ambulance scene time (26 [21-35] minutes), and telestroke to transfer center contact (median 23 [0-61] minutes). Independent predictors of DIDO time were obtaining CTA (+64.1 [29.4-98.5] minutes), use of ALS ambulance (+52.5 minutes [17.5-87.5] minutes), and use of intravenous medications besides tPA (+59.9 [15.7-104.1] minutes). Conclusions: We identified major opportunities for reducing DIDO times for inter-facility acute stroke transfers. Reducing the need for or time to CTA, earlier, streamlined transfer center contact, and using critical care ambulances are likely important strategies to decrease DIDO times.

On-line Medical Direction: A Prospective Study

1995 ◽  
Vol 10 (3) ◽  
pp. 174-177 ◽  
Author(s):  
Richard C. Wuerz ◽  
Gregory E. Swope ◽  
C. James Holliman ◽  
Gaspar Vazquez-de Miguel
Keyword(s):  
Prospective Study ◽  
Life Support ◽  
Treatment Time ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Base Station ◽  
University Hospital ◽  
Time Interval ◽  
Prehospital Treatment ◽  
On Line

AbstractObjectives:To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals.Methods:Blinded, prospective study.Setting:A university hospital base-station resource center.Participants:Ten emergency physicians, 50 advanced life support providers.Interventions:Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD.Results:Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 ± 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 ± 439 sec). Mean transport time in this system was 13 minutes.Conclusion:Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

Abstract WP385: Gender Differences in Nutritional Status After a Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Estela Sanjuan Menendez ◽  
Fidel Lopez Espuela ◽  
Juan Carlos Portilla ◽  
Katherine E Santana ◽  
Marta Holguin Mohedas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gender Differences ◽  
Nutritional Status ◽  
Acute Stroke ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Female Gender ◽  
Stroke Severity ◽  
Anthropometric Parameters ◽  
The Impact

Introduction: Malnutrition has been associated with a worse outcome in stroke. Its frequency is not well established and sometimes the impact is not considered. Objective: To explore gender differences on nutritional status (NS) after acute stroke and its impact on stroke outcome at 90 days. Methods: We evaluated consecutive acute stroke patients admitted to the Stroke Unit. We analyzed baseline demographics, vascular risk factors, analytic and anthropometric parameters, and stroke characteristics. We determined NS at baseline and 90 days by Mini Nutritional Assessment (MNA) scale to detect patients at malnutrition risk (MR). We divided groups by gender. Chi square test was applied for qualitative variables and T student for quantitative. A probability value of <0.05 was considered significant for all tests. Results: We included 95 patients, 45 women (47,4%). Differences were found comparing women vs men and age (77,9 ± 1,02 vs 75,1 ± 0,9), alcohol consumption (6,7% vs 60%), smoking (4,4% vs 26%) and body mass index (30,1 ± 5,1 vs 27,3 ± 4,5); p<0.05. There were no significant differences related to gender and stroke type (ischemic 88,9% vs 84%, p=0.49) nor stroke severity at baseline (NIHSS 5±4 vs 4±4 p=0.18), neither in risk factors (hypertension, diabetes, atrial fibrillation, dislipidemia), comorbidities nor socioeconomic differences. There were no gender differences in the occurrence of in-hospital complications (27,3% vs 16,3%; p=0,2), dysphagia (6,7% vs 6,0%; p=0.89) nor in NIHSS scoring at discharge (3±3 vs 2±3; p=0.08). On admission, MR was present in 28,5% of the patients. There were no differences between gender and DR (31,1% vs 26%; p=0.58). At 90 days, MR increased to 46,4%. We found significant gender differences (57,8% vs 32%; p=0.024). In the adjusted analysis, female gender was associated with a worst NS at 90days [OR 3,56 (1,1-11,5)]. Modified Rankin scale (mRs) score at 90 days was <=2 in 77,8% of women and 82% of men, p=0.607. MNA score at 90 days was independently associated with a better outcome (mRs<=2) at 90 days adjusted by gender OR 0,13 (0,14-0,46). Conclusion: In our series, female gender was independently related to worse nutritional status at 90 days after the stroke.

Patient Selection for Advanced Prehospital Care in a Two-Level Emergency Medical System

1989 ◽  
Vol 4 (1) ◽  
pp. 36-38 ◽  
Author(s):  
David Applebaum
Keyword(s):  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
First Aid ◽  
Emergency Medical Technicians ◽  
Emergency Medical ◽  
Dispatch System ◽  
The Impact ◽  
Selection Of Patients ◽  
Selection Of

In Jerusalem, the Emergency Medical Service is the sole prehospital provider for a population of 450,000 residents. Ambulances are dispatched from a centrally located first-aid center. Separate basic and advanced life support (MICU) ambulances are provided. Basic life support units are staffed by Emergency Medical Technicians (EMTs) trained to provide first aid and cardiopulmonary resuscitation (CPR). These units are dispatched to service persons in whom advanced life support (ALS) services are not likely to be required. The MICU is staffed by paramedical personnel plus a qualified physician. In order to maximize the efficiency of the service an attempt was made to use the MICU only for patients who may benefit from ALS interventions.Selection of patients for whom the ALS unit may be required is accomplished by switchboard operators. These personnel routinely dispatch the MICU for definite emergencies such as unconsciousness or absence of breathing. All other cases have been reported first to an on-call physician who ultimately decides whether or not to dispatch the MICU. This method of determining priority for dispatch is called the Consultation-Dispatch System (CDS). This method of determining priority seemed inefficient, so an alternative system was implemented that did not require prior physician consultation. This brief report details the impact of this change on system operation and MICU activity.

scholarly journals Delays in Stroke Onset to Hospital Arrival Time During COVID-19

Stroke ◽  
2020 ◽  
Vol 51 (7) ◽  
pp. 2228-2231 ◽  
Author(s):  
Kay-Cheong Teo ◽  
William C.Y. Leung ◽  
Yuen-Kwun Wong ◽  
Roxanna K.C. Liu ◽  
Anna H.Y. Chan ◽  
...  
Keyword(s):  
Hong Kong ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Arrival Time ◽  
Treatment Time ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Health Crisis ◽  
Hospital Arrival ◽  
Ischemic Attack

Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Methods: We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020–March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre–COVID-19: January 23, 2019–March 24, 2019). Results: Seventy-three patients in COVID-19 were compared with 89 patients in pre–COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups ( P >0.05). The median stroke onset-to-door time was ≈1-hour longer in COVID-19 compared with pre–COVID-19 (154 versus 95 minutes, P =0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P =0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P =0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups ( P >0.05 for all comparisons). Conclusions: During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.

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