Abstract WP292: Temporal Trends in the Use of Ems Service as a Mode of Arrival by Acute Ischemic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Lee H Schwamm ◽  
Sanjeeva Onteddu ◽  
Krishna Nalleballe ◽  
Kelly-Ann Patrice ◽  
...  
Keyword(s):  
African Americans ◽  
Univariate Analysis ◽  
Temporal Trends ◽  
Stroke Patients ◽  
Altered Level ◽  
Stroke Registry ◽  
Stroke Risk Factors ◽  
The Us ◽  
Ems Education ◽  
Iv Tpa

Intro: Utilization of emergency medical services (EMS) can increase the likelihood of appropriate therapy with IV tPA or endovascular intervention. We investigate the use of EMS services in three large states across the US during the past decade. Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 9,251 stroke admissions from 01/2010 - 12/2018. Overall rates of EMS use and temporal trends were computed. Factors associated with EMS use were evaluated with univariate analysis. Results: Of the 9,251 patients, 29.2 % (2,697/9,251) presented via EMS service. Overtime use of EMS service increased from 29% in 2010-11 to 34% in 2018. Use of EMS increased among severe stroke patients but decreased among mild stroke patients. Patients presenting via EMS were older, more often females while less often African Americans. They had more stroke risk factors, including hypertension, diabetes, atrial fibrillation and previous stroke/TIA. Smokers less often use EMS services. Median NIHSS was higher among patients presenting via EMS, and those with altered level of consciousness used EMS more often. In-hospital intervention rates (IV tPA/endovascular) were higher among patients presenting via EMS. Conclusion: Our results showed that after extensive EMS education in most parts of the study states, stroke presentation has increased via EMS overtime. Disparity in the use of EMS still exists with African Americans using the service less often. Patients should be encouraged to use EMS services and decrease delay in presentation which can results in higher rates of intervention.

Abstract T P267: Development of an EMS Interfacility Ground Transport Protocol for Patients During/After IV tPA Administration for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kerrin Connelly ◽  
Rishi Gupta ◽  
Raul Nogueira ◽  
Arthur Yancey ◽  
Alexander Isakov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Transport Protocol ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Public ◽  
State Office ◽  
Stroke Center ◽  
Iv Tpa

Purpose: To standardize the care of acute stroke patients who receive IV tPA being transported by ground EMS from a treating hospital to a stroke center. Background: National consensus guidelines exist for the hospital management of patients receiving IV tPA for acute ischemic stroke. Such patients require close monitoring and management to minimize risk of clinical deterioration. Although patients are often emergently transported from local hospitals to a stroke center, there are no treatment specific national guidelines for managing such patients enroute. As a result, there is a need to develop and implement a standardized approach to guide EMS personnel, particularly in states like Georgia where the public health burden of stroke is high. Methods: In 2012, the “Georgia EMS Interfacility Ground Transport Protocol for Patients during/after IV tPA Administration for Acute Ischemic Stroke” was developed in conjunction with the Georgia Coverdell Acute Stroke Registry, the Georgia State Office of EMS, a representative group of Georgia hospitals and EMS providers. Stakeholders were brought together with the goal of creating a unified statewide protocol. The intent was to create a streamlined protocol which could be readily implemented by pre-hospital care providers. Results: Stakeholders discussed challenges and opportunities to change the process of pre-hospital care. Challenges included recognition of the broad diversity of EMS providers representing over 250 agencies in the state. Opportunities included establishing the framework for greater collaboration across organizations and providers. The final protocol was endorsed by both the Georgia Coverdell Acute Stroke Registry and the State Office of EMS, and distributed to all EMS regions in Georgia. EMS agencies are currently implementing the protocol. Conclusion: Engaging a diverse group of statewide stakeholders to develop a new treatment protocol enhances success in implementation and serves to further the public health mission of improving care of acute stroke patients.

Abstract WP160: Delirium in Right Hemisphere Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sara K Rostanski ◽  
Marykay A Pavol ◽  
Marissa Barbaro ◽  
Minji Kim ◽  
Randolph S Marshall ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Cognitive Status ◽  
Screening Tools ◽  
Stroke Patients ◽  
Altered Level ◽  
Stroke Registry ◽  
Public Health Burden ◽  
Systematic Assessment ◽  
Right Hemisphere Stroke

Introduction: Delirium, a disorder of attention and arousal, poses a large public health burden. Inattention and fluctuating cognitive status, two primary delirium symptoms, also occur when specialized right brain systems are impaired. Although right hemisphere stroke may predispose to delirium, systematic assessment methods and management of these patients are not yet available. We sought to characterize the incidence of delirium in right hemisphere stroke patients and explore whether stroke localization was associated with delirium. Methods: We identified consecutive patients admitted to our stroke service with acute right hemisphere stroke over a 6-month period from our prospective stroke registry. We reviewed the medical record for core delirium symptoms: inattention, cognitive fluctuation, and either disorganized thinking, or altered level of consciousness. Delirium was assessed by systematically screening for trigger words. We compared baseline characteristics with Fisher’s exact and t-tests and assessed relation of stroke localization to delirium with logistic regression. Results: Of 105 patients with acute right hemisphere stroke, 27 (26%) had delirium. Delirium patients were older (mean age 78 vs. 68, p<0.01), more likely to have dementia (30% vs. 5%, p<0.01) and prior stroke (52% vs. 28%, p=0.03). Median length of stay was longer (5 vs. 3 days, p<0.01), and discharge home less likely (37% vs. 64%, p=0.01) in those with delirium. Delirium patients more often had strokes involving the parietal lobe (44% vs. 17%, p<0.01). In a multivariable model, parietal localization strongly predicted incident delirium (OR 3.6 95%CI 1.1-11.3, p=0.03) adjusting for age, baseline NIHSS, and premorbid dementia. Conclusion: The high delirium incidence we found supports routine delirium screening in acute stroke patients. Stroke localization may be one factor to incorporate into screening tools. Studies to prospectively identify and treat delirium in both right and left hemisphere stroke patients are warranted.

Abstract TP299: Association Between Rates of Dysphagia Screening Failure and Short-Term Outcomes in Patients With Mild Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Lee H Schwamm ◽  
Sanjeeva Onteddu ◽  
Krishna Nalleballe ◽  
Kelly-Ann Patrice ◽  
...  
Keyword(s):  
Limited Data ◽  
Stroke Patients ◽  
Entire Cohort ◽  
Stroke Registry ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
Improved Outcomes ◽  
Multivariable Regression ◽  
Mild Stroke ◽  
Screen Failure

Intro: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many patients with mild presentation fail initial screening. We sought to evaluate the rates and predictors of dysphagia screening failure in mild acute ischemic stroke patients (NIHSS < 5). Methods: Using GWTG stroke registry data from three large comprehensive stroke centers in the Northeast, South and West, we analyzed 8,687 stroke admissions from 06/2008 - 12/2018. Patients with mild stroke (NIHSS<5) were identified and dysphagia failure rate was evaluated. Using univariate and multivariable regression (MV) analysis (using factors with p<0.1, in bold), we evaluated factors associated with dysphagia screen failure in mild stroke patients. Results: Of the 8,687 patients, 3,614 (41%) had NIHSS < 5. Dysphagia screening failure was seen in 30.2% in the entire cohort while only 10.3% (373/3,614) in patients with NIHSS < 5. Mild stroke patients who failed dysphagia screening were older, more often had stroke risk factors of hypertension, hyperlipidemia, CAD/MI. They had higher median NIHSS and more often had language disturbance on presentation. Patients who failed dysphagia screening were less likely to be discharged home. On MV analysis, age (1.01, 95% 1.00, 1.02), hypertension (1.45, 95% 1.10, 1.91), NIHSS (1.62 95% 1.48, 1.77) and language disturbance at presentation (1.89 95% 1.13, 2.32) were significantly associated with initial dysphagia. Conclusion: Dysphagia screen failure rates are significantly less frequent in patients with mild symptoms and even lower for those with NIHSS of 0-1 at presentation. Factors associated with failure - older age, higher NIHSS and language disturbance at presentation may help focus efforts to avoid complications in these patients who might otherwise do well. This focused approach of screening patients all patients but targeting mild patients with dysphagia may hold potential for improved outcomes.

Abstract W P310: National Trends in Carotid Artery Stenting and Endarterectomy by Sex, Race, and Region: 2007-2011

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Thomas G Brott ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Temporal Trends ◽  
Stroke Patients ◽  
North East ◽  
The Us ◽  
Central Regions ◽  
Geographic Regions ◽  
Over Time

Background: CREST, a randomized trial comparing carotid artery stenting (CAS) with endarterectomy (CEA) in symptomatic and asymptomatic patients, reported in 2010 that the two procedures were similar for the composite endpoint of stroke, myocardial infarction, or death. Data on temporal trends in the use of these procedures in the US are limited, particularly by sex, race, and geographic region. We reviewed trends in utilization of CAS and CEA for ischemic stroke patients. Methods: Ischemic stroke hospitalizations (ICD-9 433, 434, 436) were identified for patients aged ≥18 years from the Nationwide Inpatient Sample 2007-2011 (N=480,375). Annual trends of CAS and CEA were estimated using mixed models that adjusted for patient age and comorbidities. Models were stratified by sex, race (white, black, other), and 9 geographic regions. Results: Overall, the proportion of stroke patients who received CAS remained relatively stable over time (2.7% in 2007 to 2.8% in 2011) while the proportion who received CEA decreased (from 21.0% to 16.3%). CAS rates increased in the three Central Regions (East North, East South, and West South) but decreased in New England; CEA declines were similar across regions. In adjusted analyses, CAS rates increased slightly for white men, decreased for men and women of other race, but remained stable for the remaining groups (Figure); CEA rates decreased for all sex-race groups. These patterns by sex and race subgroups were generally consistent across geographic regions. Conclusions: The proportion of hospitalized stroke patients receiving CEA decreased over time while CAS rates remained relatively stable, with slight increases seen in the Central regions of the US. There are sex-race differences in the proportion of patients who receive these procedures, but these patterns are largely similar across regions.

scholarly journals HUBUNGAN DISFAGIA DAN PENURUNAN KESADARAN TERHADAP PNEUMONIA ASPIRASI PADA PASIEN STROKE RS ATMA JAYA

2018 ◽  
Vol 36 (1) ◽  
Author(s):  
Michael Nathaniel Budiarso ◽  
Linda Suryakusuma ◽  
Luse Luse ◽  
Vetinly Vetinly
Keyword(s):  
Aspiration Pneumonia ◽  
Stroke Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Altered Level ◽  
Stroke Registry ◽  
Level Of Consciousness ◽  
Chi Square Test ◽  
Life Habits ◽  
Risk Of Aspiration

   THE CORRELATION BETWEEN DISHAGIA AND ALTERED LEVEL OF CONSCIOUSNESS WITH ASPIRATION PNEUMONIA IN STROKE PATIENTS AT ATMA JAYA HOSPITALABSTRACTIntroduction: Approximately 40-96% of stroke patients will develop complications; the most frequent is pneumonia (33%). This is due to the underlying clinical manifestation of stroke such as dysphagia, immobilization, altered level of consciousness, and immune suppression which increases the risk of aspiration, therefore increases the risk for aspiration pneumonia. Early detection of aspiration pneumonia and its risk factors in stroke patients are essential, but the number of researches regarding this in Indonesia is still limited.Aims: To study the correlation between dysphagia and altered level of consciousness in stroke patients with aspiration pneumonia in Atma Jaya Hospital, Jakarta.Methods: This is a retrospective cohort research with a cross sectional approach towards 263 stroke patients in Atma Jaya Hospital, February 2016 until October 2017. Data was taken from the stroke registry and medical records, and analized with Chi-square test (α=0.05).Results: The incidence for aspiration pneumonia was 16% in the study population, most of which being male (57.8%), age <65 years old (79.5%), and length of education <9 years (71.5%). Age >65, dysphagia and altered level of consciousness were statistically significant with Odds ratio (OR) 2.26, 3.92, and 8.67, respectively.Discussion: Male, age <65 years old, and length of education <9 years were correlated with poor daily life habits which increases the risk of getting a stroke. Age >65 years old, dysphagia and altered level of consciousness can disturb the coordination and swallowing reflex which makes patients more vulnerable to aspiration and develop aspiration pneumonia.Keywords: Altered level of consciousness, aspiration pneumonia, dysphagia, strokeABSTRAKPendahuluan: Sebanyak 40-96% pasien stroke akan mengalami komplikasi, terutama pneumonia (33%). Hal ini dimungkinkan oleh adanya kecenderungan disfagia, imobilitas, penurunan kesadaran, dan supresi imunitas yang mempermudah terjadinya aspirasi hingga terjadi pneumonia aspirasi. Deteksi awal faktor risiko pneumonia aspirasi pada pasien stroke sangat penting, namun penelitiannya masih terbatas di Indonesia.Tujuan: Mengetahui hubungan antara disfagia dan penurunan kesadaran terhadap kejadian pneumonia aspirasi pada pasien stroke di RS Atma Jaya, Jakarta.Metode: Penelitian kohort retrospektif dengan pendekatan potong lintang terhadap 263 pasien stroke di RS Atma Jaya. Penelitian dilakukan mulai Februari 2016-Oktober 2017. Data diperoleh melalui data register stroke dan rekam medis. Analisis dilakukan menggunakan uji Chi-square dengan nilai α=0,05.Hasil: Insiden pneumonia aspirasi pada pasien stroke adalah 16%. Didapatkan mayoritas populasi laki-laki (57,8%) berusia <65 tahun (79,5%), dan berpendidikan <9 tahun (71,5%). Usia >65 tahun, disfagia, dan penurunan kesadaran memiliki hubungan yang bermakna secara statistik terhadap kejadian pneumonia aspirasi dengan rasio Odds (RO) 2,26, 3,92, dan 8,67 kali lipat.Diskusi: Laki-laki, usia <65 tahun, dan pendidikan <9 tahun berkaitan dengan pola kesehatan hidup buruk yang meningkatkan faktor risiko terjadinya stroke. Usia >65 tahun, disfagia, dan penurunan kesadaran dapat mengganggu koordinasi dan refleks menelan, sehingga pasien stroke lebih rentan terjadi aspirasi dan mengalami pneumonia aspirasi.Kata kunci:  Disfagia, penurunan kesadaran, pneumonia aspirasi, stroke

scholarly journals Pneumonia risk factors in stroke patients

Revista CEFAC ◽  
2020 ◽  
Vol 22 (6) ◽  
Author(s):  
Paulo Mateus Madureira Soares Mariano ◽  
Mateus de Sousa Rodrigues ◽  
Leonardo Fernandes e Santana ◽  
Manoel Pereira Guimarães ◽  
Paulo Adriano Schwingel ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Older Age ◽  
Stroke Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Stroke Registry ◽  
Post Stroke

ABSTRACT Purpose: to assess the demographic and clinical characteristics associated with the development of pneumonia in post-stroke patients hospitalized in a tertiary hospital, located in the Vale do São Francisco, that covers the states of Pernambuco and Bahia, Brazil. Methods: a unicentric, observational, analytical, cross-sectional study, based on the medical records of patients diagnosed with stroke and included in the Stroke Registry (RAVESS study). The statistical analysis was made with the chi-square test, Fisher’s exact test, and the analysis of variance, with the Bonferroni’s post-test, and P≤0.05. Results: data from 69 patients presented with acute stroke were collected, aged 63.2±16.8 years; 37 (53.6%) were females; the prevalence of pneumonia during hospital stay was estimated at 31.9% (95% confidence interval: 21.2-44.2%). In the univariate analysis of predictors for post-stroke pneumonia, the following were identified: older age (72.6±17.9 vs. 58.8±14.5; P = 0.001), lower response signal to the Glasgow Coma Scale at admission (11.3±1.8 vs. 13.3±2.1; P = 0.001), and higher frequency of dysarthria at admission (61.9% vs. 27.9%; P = 0.009). Conclusion: pneumonia was a prevalent complication in post-stroke patients at a Brazilian tertiary hospital. It was related to the patient’s older age and the severity of the cerebral event.

Abstract 2545: Does Participation in a Stroke Registry Improve tPA Administration Rates?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Moges Ido ◽  
Lydia Clarkson ◽  
Deborah Camp ◽  
Kerrie Krompf ◽  
Michael Frankel
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Patient Care ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Hospital Size ◽  
Stroke Registry ◽  
Over Time ◽  
Iv Tpa

Background: The purpose of the Georgia Coverdell Acute Stroke Registry (GCASR) is to improve the quality of patient care. GCASR conducts regular quality improvement activities to educate hospital staff and improve systems and processes. Administration of intravenous tissue plasminogen activator (IV tPA) is standard treatment for eligible acute ischemic stroke patients and can dramatically improve outcomes. Purpose: To determine whether GCASR hospitals were more likely to administer tPA to acute ischemic stroke patients than non-GCASR hospitals. Methods: Hospitalization data from acute care hospitals in Georgia was provided by the Georgia Hospital Association for November 2005 through December 2009. Acute ischemic stroke patients receiving tPA were identified using ICD-9 codes (433 and 434), procedure codes (9910), and healthcare common procedure system codes (J2997). A hospital was defined as a GCASR facility if it was actively participating in the registry at the time of patient hospitalization. A generalized estimating equation with robust variance estimation was applied using the SAS GLIMMIX procedure. “Hospital” was treated as a random variable. Relative risks for receiving tPA were estimated and adjusted for demographics, co-morbidities, hospital size, urbanicity, and length of stay. Results: A total of 55,403 patients were admitted with a principal diagnosis of acute ischemic stroke during the study period, and two percent (1,231) received tPA. Three percent of patients (871) seen at registry facilities received tPA, compared to 1.4% (360) of those seen at non-GCASR facilities. Age, gender, race, length of stay, hospital size, and participation in the registry all predicted tPA administration, either at or near significant levels (p-values from <0.0001 to 0.0646). Although IV tPA administration has increased over time in both hospital groups, patients treated at GCASR facilities were more likely to receive tPA after controlling for confounders (OR=1.64; 95% CI: 0.97-2.78), which approached significance (p=0.0646). Approximately 340 fewer people would have received tPA had all study patients been treated at non-GCASR facilities. Conclusions: Although all Georgia hospitals have improved their rate of tPA administration over time, GCASR hospitals maintained a higher rate than non-GCASR hospitals. This may be due in part to the quality improvement activities that registry facilities participate in and the assistance they receive. These results support the stroke registry model as a method of improving stroke patient care and outcomes.

scholarly journals Estonian young stroke registry: High burden of risk factors and high prevalence of cardiomebolic and large-artery stroke

2021 ◽  
pp. 239698732110409
Author(s):  
Riina Vibo ◽  
Siim Schneider ◽  
Liisa Kõrv ◽  
Sandra Mallene ◽  
Liisi-Anette Torop ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Young Patients ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Young Stroke ◽  
Stroke Risk Factors ◽  
High Prevalence

Background and aims The aim of the present study was to assess the risk factor burden and stroke etiology of young stroke patients in Estonia and to compare the results with similar cohorts from other countries. Methods This study includes ischemic stroke patients aged 18–54 years from the prospective Estonian Young Stroke Registry between 2013 and 2020. All patients were managed in a stroke unit following a prespecified detailed protocol. Data on stroke risk factors, etiology, and stroke severity were analyzed. Results A total of 437 patients (mean age 44.7 ± 8.3 years; 62% males) were included in the registry during the 8-year study period. A total of 50.2% of patients had ≥ 3 well-documented risk factors (higher for men: odds ratio (OR) 3.8; 95% cardiac index confidence interval (CI) 1.8–8.3; p < .001) and 6.2% of patients had ≥ 3 less well-documented risk factors. While 42% of patients had undetermined cause of stroke (34% of them cryptogenic), the second most frequent etiologies were large-artery atherosclerosis and cardioembolism (both 19%). 60 percent of cardioembolic strokes were due to high-risk causes. Large-artery atherosclerosis was more prevalent in men (OR 1.8; 95% CI 1–3.3; p = .05) and among older patients (OR 6.2; 95% CI 1.8–21.4; p = .008). The median National Institutes of Health Stroke Scale score on admission was 3 (interquartile ranges 2–6), stroke was more severe in men ( p = .05). Conclusions Our study revealed that young patients with stroke in Estonia have higher burden of well-documented risk factors, higher prevalence of high-risk cardioembolic causes and higher prevalence of large-artery stroke compared to other young stroke cohorts.

Abstract WMP32: Variation in the Rates of Acute Ischemic Stroke Transfers Between Hospitals in the United States

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Syed F Ali ◽  
Gregg Fonarow ◽  
Eric Smith ◽  
Li Liang ◽  
Robert Sutter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
High Volume ◽  
The United States ◽  
Teaching Hospitals ◽  
Large Sample Size ◽  
Stroke Registry ◽  
Intravenous Tissue Plasminogen Activator ◽  
The Us ◽  
Iv Tpa

Background: Many patients are transferred from emergency departments or inpatient units to stroke centers for advanced acute ischemic stroke (AIS) care, especially after intravenous tissue plasminogen activator (tPA). We sought to determine variation in the rates of AIS patient transfer in the US. Methods: Using data from the national Get With The Guidelines-Stroke registry, we analyzed AIS cases from 01/2010 to 03/14. Transfer-in was defined as transfer of AIS patients from other hospitals. Due to large sample size, instead of p-values, standardized differences were reported and a map of transfer-in rates across the US constructed. Results: Of the 970,390 patients discharged from 1,646 hospitals in the US, 87% were admitted via the ER or direct admission (front door) vs. 13% transferred-in. While most hospitals (61%) had transfer-in rates of < 5% of all AIS patients, a minority (17%) had high (>15%) transfer-in rates. High transfer-in hospitals were more often in the Midwest, were larger, and had higher annual AIS and IV tPA case volumes, and were also more often teaching hospitals and stroke centers (primary or comprehensive) (Table and Figure).. IV tPA was used more frequently in eligible patients in high-volume transfer-in hospitals (Table); otherwise, stroke quality of care was similar. Conclusions: There is significant regional- and state-level variability in the transfer of AIS patients. This may reflect differences in resource availability and the distribution of smaller, under-resourced hospitals that frequently transfer patients for advanced care after stabilization. Additional research is warranted to understand this variation.

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