Abstract T P251: Factors for Delayed Medical Care Seeking among Elderly Stroke Patients in Korea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jeongha sim ◽  
Dongchoon Ahn ◽  
cha-nam shin
Keyword(s):  
Ischemic Stroke ◽  
Medical Care ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Care Seeking ◽  
Stroke Patients ◽  
Convenience Sample ◽  
Hospital Arrival ◽  
Stroke Education ◽  
Korean Elderly

Background: Stroke is the second leading cause of death in Korea and the prevalence of acute ischemic stroke among older adults continues to grow, which is known to be related to delayed hospital arrival after the onset of symptoms. Thus, decreasing the incidence of elderly stroke is a major health promotion objective in Korea, yet little is reported about the factors associated with the delayed medical care seeking behavior among elderly stroke patients in Korea. Purpose: The purpose of this study was to understand factors of delayed medical care seeking among elderly stroke patients in order to develop intervention strategies to improve the health of this population. Methods: A cross-sectional, descriptive study was conducted in a convenience sample of 233 hospitalized elderly patients with acute ischemic stroke using a self-administered survey. Descriptive statistics and chi-square test were used for data analysis. Results: More than half of them were male (60.5%) with age of 61 and older (76.9%), and relied on the opinion of their children or friends when deciding medical care for stroke (58.3%). Regarding the reasons of seeking medical care, there was no statistical significance between individuals who arrived at a hospital within three hours of the onset of symptoms and who arrived after three hours. Reasons for delayed hospital arrival were significantly different between groups (individuals of hospital arrival within three hours vs. individuals with hospital arrival after three hours), which include lack of knowledge about the severity of stroke and unawareness of symptoms (χ2 = 24.1), or inconvenience of a hospital visit, waiting for the effects of alternative medications, and stroke during sleep (χ2 = 55.1) with p <0.001. Conclusions: In conclusion, this study helped identify factors delaying hospital arrival after the onset of symptoms among Korean elderly stroke patients. Interventions should include stroke education focusing on the severity of stroke and related symptoms. The stroke education should target not only elderly stroke patients but their family members and friends. It may result in overall national health by decreasing prevalence of stroke among Korean elderly population.

Social factors influencing hospital arrival time in acute ischemic stroke patients

2011 ◽  
Vol 54 (4) ◽  
pp. 361-367 ◽  
Author(s):  
Christina Iosif ◽  
Mathilda Papathanasiou ◽  
Eleftherios Staboulis ◽  
Athanasios Gouliamos
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Social Factors ◽  
Arrival Time ◽  
Stroke Patients ◽  
Hospital Arrival ◽  
Factors Influencing

Abstract P13: Faster Treatment Speed is Not Associated With Bleeds: Intravenous Alteplase Treatment in the Ultra-Early Time Window is Safe

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Provencher ◽  
Ashley Scherman ◽  
Elizabeth Baraban ◽  
Robert Jackson ◽  
Tamela L Stuchiner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Statistical Significance ◽  
Hospital Length Of Stay ◽  
Bleeding Complications ◽  
Stroke Patients ◽  
Related Complication ◽  
Discharge Disposition ◽  
Significant Difference

Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications. Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history. Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance. Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.

scholarly journals Effects of Community-based Stroke Education and Advocacy on the Time from Stroke Onset to Hospital Arrival in Ischemic Stroke Patients

2015 ◽  
Vol 33 (4) ◽  
pp. 265-271 ◽  
Author(s):  
Young-Hoon Lee ◽  
Hyun Young Park ◽  
Hak-Seung Lee ◽  
Yeon-Soo Ha ◽  
Jin-Sung Cheong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Community Based ◽  
Hospital Arrival ◽  
Stroke Education

Abstract 145: Endovascular Thrombectomy for Large Vessel Ischemic Stroke Patients With Low Aspects: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jose Danilo Diestro ◽  
Adam Dmytriw ◽  
Gabriel Broocks ◽  
Andrew Kemmling ◽  
Karen Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Large Vessel ◽  
Cochrane Central Register ◽  
Large Core ◽  
Stroke Patients ◽  
Endovascular Thrombectomy

Background: Most trials for the endovascular thrombectomy (EVT) of large vessel ischemic stroke excluded patients with large core infarcts and low Alberta Stroke Program Early CT Score (ASPECTS). As a result, the current American Heart Association guidelines for acute ischemic stroke reserve Grade 1A recommendation for the use of EVT for patients with an ASPECTS of 6 or more. However recent data from the HERMES collaboration has shown that even stroke patients with large core infarcts may still benefit from EVT. Objectives: Through this systematic review, we aim to determine the safety and efficacy of EVT for large vessel ischemic stroke patients with low ASPECTS (5 or less). Methods: Medline, Cochrane Central Register of Systematic Reviews and ClinicalTrials.gov were searched for studies appraising the outcomes of EVT for low ASPECTS acute ischemic stroke patients. Patients with low ASPECTS who underwent EVT were compared to those who only received best medical therapy (BMT). A meta-analysis of proportions was done to compare the outcomes of the two groups in terms of symptomatic intracranial hemorrhage, mortality and good 3-month functional outcomes (modified Rankin Scale < 2). Results: Nine studies with a total of 1,196 acutes stroke patients with low ASPECTS (712 undergoing EVT and 484 with only BMT) were included in the study. There was a trend towards a higher rate of sICH in the EVT group (9.2%; 95% CI 6.1% to 13.6%; I 2 53.37%) compared to the BMT group (5.5%; 95% CI 3.7% to 8.1%; I 2 =0%) but this did not reach statistical significance (p=0.11). There was no difference (p=0.41) in the pooled 3-month mortality of EVT patients (30.7%; 95% CI 21.7 to 41.5%; I 2 84.23%) and BMT patients (36.6%; 95% CI 26.4% to 48.1%; I 2 76.2%). Patients who underwent EVT had significantly better (p=0.001) 3-month outcomes, with 27.7% (95% 21.8 to 34.5%; I 2 62.08%) of patients attaining an MRS 0-2 compared to only 3.7% (95% 2.3 to 5.9%; I 2 87.21%) of patients in the BMT. Conclusion: Our meta-analysis suggests that acute stroke patients with low ASPECTS score may still benefit from EVT. Larger registry based studies and randomized controlled trials are needed to further substantiate the findings of our review.

Abstract T P298: Impact of Accurate Weight Based Dosing of IV tPA in Acute Ischemic Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vishal B Jani ◽  
Sopan Lahewala ◽  
Shilpkumar Arora ◽  
Erin Shell ◽  
Anmar Razak ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Stroke Severity ◽  
Fisher Exact Test ◽  
Weight Estimation ◽  
Stroke Patients ◽  
Significant Difference ◽  
Iv Tpa

Background: Accurate weight-based dosing is essential for efficacy and safety of thrombolysis in acute ischemic stroke (AIS). Stroke patients may be unable to communicate correct body weight (BW). Dosing may be estimated which can lead to error. Objective: To assess accuracy of weight estimation and the effect of weight and dosing discrepancy on outcome of patients with AIS Methods: 94 patients receiving IV tpa for AIS in a CSC registry between Feb, 2013 and Jul, 2014 were reviewed. All were given estimated weight based tPA- per patient input or agreement of 2 providers in ER. Accurate weights were obtained and recorded later. Actual weight was used to calculate the ideal TPA doses and compared to the weights and doses used. The cohort was separated into two groups based on weight discrepancy to those 10 kg (non forgiven) discrepancy. Rate of hemorrhage, NIHSS and hospice/mortality were assessed. Difference between categorical variables was tested using the chi-square and Fisher’ Exact Test. Differences between continuous variables were tested using Wilcoxon Rank Sum test and presented with median and IQ range. Results: 86.1% (forgiven cohort) were given the optimal tPA dose despite estimation. There was a significant difference in stroke severity based on admission NIHSS between the cohorts (33.3% in forgiven vs. 69.2% non-forgiven. P=0.04). Stroke severity based on discharge NIHSS did not reach statistical significance (mild: 71.8% vs 63.6%, moderate: 16.9% vs 9.1% and severe: 11.3% vs 27.3%, p = 0.32). 30 days modified Rankin Scale (mRS) was available for 52 pts without any significant difference (good outcome 44.4% vs 57.1%, poor outcome 35.6 % vs 28.6 %, p = 0.82). Statistically non significance toward higher rate of hemorrhagic conversion (6.4% vs 7.7%, p = 0.41), and higher mortality in non-forgiven group (7.41% vs 15.38%, p= 0.33). Conclusion: Accurate BW measurement prior tPA still remains challenging. In this study, weight estimation by 2 providers is fairly accurate. 14 % of the patients with discrepancy of > 10 kg had higher rate of mortality and hemorrhage although this was not statistically significant. Further studies with larger sample sizes are needed to examine the safety of weight estimation in AIS patients who receive IV tpa

Factors associated with early hospital arrival in acute ischemic stroke patients

2014 ◽  
Vol 35 (10) ◽  
pp. 1567-1572 ◽  
Author(s):  
Esin Kulein Koksal ◽  
Sibel Gazioglu ◽  
Cavit Boz ◽  
Gamze Can ◽  
Zekeriya Alioglu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Hospital Arrival ◽  
Factors Associated

Abstract NS5: Improvement of Follow-up Rate After Discharge of Acute Ischemic Stroke Patients by the Man-to-man Education for Stroke During Admission

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hee Sun Yu ◽  
Na Young Yun ◽  
Jong Wook Shin ◽  
Hye Seon Jeong ◽  
Sangeun Yoo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Education Program ◽  
Drug Information ◽  
Warning Signs ◽  
Stroke Patients ◽  
Nutrition Behavior ◽  
Number Of Patients ◽  
Stroke Education

Background: We have executed a man-to-man stroke education program for acute ischemic stroke patients during admission since 2012. The contents of the man-to-man stroke education includes warning signs of stroke, guidance for prompt actions after symptom onset, drug information, and exercise and nutrition behavior after discharge. We evaluated whether the man-to-man education given during admission is effective to improve follow-up rates after discharge for acute ischemic stroke patients. Methods: We compared clinical data including modified Rankin Scale (mRS) at discharge and length of stay and follow-up data after discharge of 697 acute ischemic stroke patients (Male:Female=283:414, mean age±SD, 69.0±12.1 years) admitted in 2013, who received the man-to-man education during admission, with the data of 602 patients (M:F=254:348, 67.1±12.2 years) admitted in 2008, who did not receive the active education during admission. To evaluate follow-up rates, we first checked the follow-up status of all included patients within 1, 4, 8, 12, 16 months after discharge. Then, follow-up rates at each time point were calculated as the ratio of the number of patients followed at the point to the all patients discharged in 2008 or 2013. Differences of the follow-up rates between 2008 and 2013 were compared at individual follow-up time points using one-sided x2-test. Results: Even though the favorable outcome defined as 0-3 of mRS at discharge was similar between 2008 and 2013 (2008 vs. 2013, 88.3 vs. 87.4%, p=0.342), length of admission was significantly shorter in 2013 than 2008 (2008 vs. 2013, 10.2 vs. 6.6 days, p<0.001). On follow-up rates evaluations, follow-up at 1 month was significantly higher in 2013 (89.8%) than 2008 patients (83.7%) (p=0.001). The follow-up rates subsequently decreased at 4months (2008 vs. 2013, 77.3 vs. 81.5%, p=0.040), 8 months (70.1 vs. 74.3%, p=0.051), 12 months (63.1vs. 67.6%, p=0.052), and 16 months (57.6 vs. 63.0%, p=0.028). However, the follow-up rates of 2013 patients was consistently higher than 2008 ones. Conclusion: The present data suggested that active education program for acute ischemic stroke patients could improve to follow-up rates of the patients after discharge.

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