Abstract WP37: Endovascular Thrombectomy Practice Pattern Across the Nihss Spectrum

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amelia Kenner-brininger ◽  
Lindsay Olson-Mack ◽  
Lorraine Calzone ◽  
Kristi L Koenig ◽  
Thomas M Hemmen
Keyword(s):  
Clinical Trials ◽  
Care Facility ◽  
Health Care Facility ◽  
Hospital Death ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Severe Stroke ◽  
Stroke Registry ◽  
Skin Puncture ◽  
Number Of Patients

Background: Endovascular thrombectomy (EVT) after Ischemic Stroke (AIS) has shown to improve outcomes in multiple large clinical trials. However, most guidelines recommend EVT for patients with NIHSS greater than 5 and caution EVT in severe stroke. We analyzed data from a stroke registry to learn about ‘real-world’ use of EVT across stroke serverity. Most clinical trials focus on academic medical centers. Our analysis reports on data from all centers within a region. Methods: The San Diego County EMS Stroke Registry represents data from 10 EVT ready centers. We included all AIS cases with NIHSS between 0 and 42 from July 2016 through December 2018. Patients were grouped into three categories: 1) NIHSS 0-5, 2) 6-25, 3) 26-42. We analyzed frequency of EVT use, last known normal (LKN) to skin puncture time, admission NIHSS in EVT cases, and hospital discharge dispositon of EVT cases. Results: Of 7,050 AIS cases, 662 (9.4%) received EVT from July 2016 to December 2018. Group (G) 1: 80 of 4184 cases received EVT (1.9%), G2: 470 of 2502 cases received EVT (18.8%), G3: 112 of 364 cases received EVT (30.8%). Rate of EVT in all AIS and for each NIHSS group did not change (all AIS: p=.24, G1: p=.59, G2: p=.15, G3: p=.57). Mean (±SD) NIHSS among all AIS was 7.4 (±8.5); among EVT cases it was 17.2 (±8.6). Mean (±SD) LKN to skin puncture (hours) was G1: 9.2 (±12.1), G2: 5.8 (±5.8), G3: 5.5 (±5.3) (p=.000001). Mean (±SD) age (years) of EVT cases was G1: 65.5 (±15.4); G2: 71.9 (±15.6); , G3: 77.1 (±14.0) (p=.00001). Discharge to home among EVT cases was Group 1: 50.0%; 2) 26.5%; 3) 9.8%; to a non-acute health care facility: G1) 28.8%, 2) 39.5%, 3) 44.6%); in-hospital death 1) 10.0%, 2) 13.6%, 3) 25.0%. Conclusion: Patients with mild and severe stroke present a significant subpopulation of patients undergoing EVT in this sample. Overall, one in three stroke patients with NIHSS above 25 underwent EVT; less than one in five stroke patients with low NIHSS underwent EVT. Over time there has been no change in the number of patients receiving EVT and no change in EVT use within NIHSS groups. Half of patients with low NIHSS were discharged home; one in four patients with high NIHSS expired in hospital. As hospitals embraced EVT, the use of the procedure among patients with low or high NIHSS has remained consistent.

scholarly journals Changes in Stroke Patients’ Health-Seeking Behavior by COVID-19 Epidemic Regions: Data from the Korean Stroke Registry

2021 ◽  
pp. 1-9
Author(s):  
Han-Yeong Jeong ◽  
Eung-Joon Lee ◽  
Min Kyoung Kang ◽  
Ki-Woong Nam ◽  
Jeonghoon Bae ◽  
...  
Keyword(s):  
Intravenous Thrombolysis ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Health Seeking ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Care Services ◽  
Health Seeking Behaviors ◽  
Number Of Patients ◽  
Using Data

<b><i>Introduction:</i></b> The coronavirus disease 2019 (COVID-19) pandemic has led to changes in stroke patients’ healthcare use. This study evaluated changes in Korean stroke patients’ health-seeking behaviors and stroke care services using data from the Korean Stroke Registry (KSR). <b><i>Methods:</i></b> We reviewed data from patients with acute stroke and transient ischemic attack (TIA) during 2019 (before COVID-19 period) and 2020 (COVID-19 period). Outcomes included patient characteristics, time from stroke onset to hospital arrival, and in-hospital stroke pathways. Subgroup analyses were performed for an epidemic region (Daegu city and Gyeongsangbuk-do region, the D-G region). <b><i>Results:</i></b> The study included 1,792 patients from the pre-COVID-19 period and 1,555 patients from the COVID-19 period who visited hospitals that contribute to the KSR. During the COVID-19 period, the D-G region had two-thirds the number of cases (vs. the pre-CO­VID-19 period) and a significant decrease in the proportion of patients with TIA (9.97%–2.91%). Unlike other regions, the median onset-to-door time increased significantly in the D-G region (361 min vs. 526.5 min, <i>p</i> = 0.016), and longer onset-to-door times were common for patients with mild symptoms and who were in their 60s or 70s. The number of patients who underwent intravenous thrombolysis also decreased during the COVID-19 period, although the treatment times were not significantly different between the 2 periods. <b><i>Discussion/Conclusion:</i></b> Korean stroke patients in a CO­VID-19 epidemic region exhibited distinct changes in health-seeking behaviors. Appropriate triage system and public education regarding the importance of early treatment are needed during the COVID-19 pandemic.

scholarly journals Clinicoepidemiological profile of ear, nose, throat patients in outpatient clinic of tertiary health care facility in Punjab

2020 ◽  
Vol 7 (11) ◽  
pp. 4522
Author(s):  
Manish Munjal ◽  
Anurag Chowdhary ◽  
Harsimran Bhatti ◽  
Porshia Rishi ◽  
Nitika Tuli ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Care Facility ◽  
Health Care Facility ◽  
Neck Surgery ◽  
North India ◽  
Care Hospital ◽  
Number Of Patients

Background: This study evaluated the profile of ailments in patients presenting to outpatient clinic of tertiary care hospital of North India that caters to ENT diseases in population of Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir.Methods: A retrospective study was undertaken by analysing the medical records of patients managed at the department of otorhinolaryngology and head and neck surgery at the tertiary care hospital, Punjab from Jan 2018 to Dec 2018 and all essential data was collected.Results: Total no. of patients presenting to the ENT OPD during the period of assesment were 32,475.  49.30% were males and 50.70 % were females, respectively. 29.70% were children below 15 years. The number of patients presenting per month were 2706, with maximum no. of patients presenting in the month of August to November. Patients with ear diseases were 9280 (28.57%), Nose diseases were 11963 (36.83%), and throat diseases were 11232 (34.58%).Conclusions: This study showed that awareness of ENT ailments and visits for specialised treatment is on the rise rather than primary level treatment at local or general medicine or family physician level.

scholarly journals Outcomes of Endovascular Therapy in Patients With Prestroke Mobility Impairment

Stroke ◽  
2021 ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H. Schwamm ◽  
Eric E. Smith ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Hospital Death ◽  
Limited Data ◽  
Mobility Impairment ◽  
Data Set ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Symptomatic Intracranial Hemorrhage ◽  
Get With The Guidelines

Background and Purpose: Patients with prestroke mobility impairment (PSMI) were excluded from endovascular clinical trials. There are limited data regarding safety and outcomes of endovascular thrombectomy in this population. We used a large, national data set (Get With The Guidelines–Stroke) to evaluate the safety and outcomes of endovascular thrombectomy in patients with PSMI. Methods: We included patients who underwent endovascular thrombectomy in the Get With The Guidelines–Stroke registry between 2015 and 2019. PSMI was defined as the inability to ambulate independently. Generalized estimating equations for logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56 762 patients treated with endovascular thrombectomy, 2919 (5.14%) had PSMI. PSMI was not associated with symptomatic intracranial hemorrhage (6.0% versus 5.4%; P =0.979). In-hospital death or discharge to hospice occurred in 32.3% of patients with PSMI versus 17.5% without PSMI (adjusted odds ratio, 1.45 [1.32–1.58]). Conclusions: While procedural adverse outcomes were no higher in patients with PSMI, further study is necessary to determine clinical benefit in this population.

scholarly journals Rationing of Nursing Care on Example of Selected Health Care Facility

2021 ◽  
Vol 18 (23) ◽  
pp. 12824
Author(s):  
Katarzyna Tomaszewska ◽  
Bożena Majchrowicz ◽  
Dorota Ratusznik
Keyword(s):  
Health Care ◽  
Nursing Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Determinants ◽  
Adequate Care ◽  
Number Of Patients ◽  
The Mean ◽  
Care Rationing ◽  
Hospital Wards

Contemporary health determinants require nurses to develop new competencies and skills while performing complex tasks in all forms of health care. The problem of rationing of care is present all over the world and usually occurs when available resources are too low to provide adequate care to all patients. The most common reasons for loss of care are shortages of nurses, use of modern treatment methods, increased demand for care by a large number of patients, and greater knowledge of patients about their rights. A questionnaire survey was conducted among 295 nurses employed in hospital wards. The survey was conducted from September to December 2020 using the standardized BERNCA (The Basel Extent of Rationing of Nursing Care) questionnaire to measure the level of rationing of nursing care. The research was hampered by the sanitation regime associated with the SARS CoV-2 pandemic. Nursing care rationing is dependent on seniority and place of work. The mean total BERNCA score of the degree of rationing of nursing care was 2.58 ± 0.96 on a scale of 0 to 4 (where 0 means “no need for it” and 4 means “often”. The median score was 2.69. The higher frequency of rationing nursing care was characteristic of those working on surgical wards. The mean score obtained by them was 2.72 ± 0.86, with the median equal to 2.88. In the case of nurses employed in non-surgical wards, the scores were 2.08 ± 1.07 and 2.28, respectively. Rationing of nursing care is dependent on seniority and work location, with a higher degree of rationing of care occurring in surgical units.

Abstract P150: Effects of State Mandated Stay-At-Home Orders on Timely Presentation of Ischemic Stroke Patients During the Covid-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Trevor Barton ◽  
Rebecca Van Vliet ◽  
Chris Fanale ◽  
Jeffrey Wagner
Keyword(s):  
Ischemic Stroke ◽  
State Governments ◽  
Treatment Rate ◽  
Stroke Patients ◽  
Timely Manner ◽  
Severe Stroke ◽  
Number Of Patients ◽  
The Difference ◽  
The Government ◽  
At Home

Introduction: The ability to treat an acute ischemic stroke depends on the patient’s timely presentation to the hospital from their last known well time. During the coronavirus disease 2019 (COVID-19) pandemic, individual state governments enacted stay-at-home orders to slow the transmission of the disease. We collected data from hospitals across four state-based networks where we provide stroke telemedicine coverage to ascertain the effects of these mandates. Objectives: We sought to evaluate the effects of stay-at-home orders on the number of patients evaluated and treated for ischemic stroke during the COVID-19 pandemic, and to evaluate the difference in treatment rate while states were under state-at-home orders versus while they were not. Methods: We retrospectively examined stroke alerts from March 1 st to May 30 th , 2020. We tabulated total number of stroke alerts, number of IV alteplase and intra-arterial (IA) treatment recommendations, number of less severe strokes (NIHSS 0-6) and more severe strokes (NIHSS 7-41). Treatment rates were calculated and compared by state-based network before, during, and after the stay-at-home orders. Results: We found that the total number of alerts per week fell by 27.33% during the stay-at-home orders across all state networks. The total number of patients treated with alteplase and total number of patients treated with IA therapy per week also dropped by 29.31% and 13.69%, respectively. The alteplase and IA treatment rate increased by 10.57% and 13.85%, respectively, during the stay-at- home orders. The percentage of total strokes considered more severe slightly increased during these orders, by 5.54%. Conclusion: During the government mandated stay-at-home orders, the total number of patients evaluated for stroke alerts decreased, as did the total number of patients treated either with alteplase or IA therapy. However, with the decrease in number treated, the rate at which patients were treated with alteplase, IA, or both, increased. The percentage of total strokes that were considered more severe slightly increased. In conclusion, while stay-at-home orders kept many stroke patients home, the most severe stroke patients continued to present to the hospital and were treated in a timely manner via telemedicine.

scholarly journals LO65: Safety and satisfaction of a new program redirecting low-acuity emergency department patients to medical clinic: a prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S29-S30 ◽  
Author(s):  
J. Morris ◽  
R. Daoust ◽  
A. Cournoyer ◽  
M. Marquis ◽  
J. Chauny ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Medical Clinics ◽  
Tertiary Care Facility ◽  
Number Of Patients ◽  
Computer Based

Introduction: Overcrowding in emergency departments (EDs) is a constant problem. One of the major factors contributing to this situation is the inappropriate ED use by patients with low-acuity problems. In order to reduce overuse, EDs have developed agreements with clinics to reorient low-acuity ambulatory patients toward them. These agreements often leave the burden of decision on the triage personnel as to which patients can be safely redirected. The aim of this study was to evaluate the safety of redirecting patients to nearby medical clinics and to evaluate their satisfaction with this program. Methods: In the ED of a tertiary care facility, a computer-based algorithm allowing triage personnel to reorient patients presenting with one of 52 medical complaints, was implemented in 2016. Our prospective cohort study was composed of reorientation admissible ED patients between March 2017 and August 2017. Patient safety was evaluated with patient follow-up phone interviews one week after their visit to the ED to identify the number of patients who needed to return to a medical facility after their reorientation. Patient satisfaction with the reorientation program was evaluated during the same follow-ups. Results: Of the 980 reoriented patients interviewed, only 57 (5.9%; 95% confidence interval [CI] 4.57.5) had to unexpectedly go back to a health care facility. None of these returns were for severe complications. Over 84% of the reoriented patients were satisfied with their reorientation and 89% say they would use this program again. Having a transportation problem was most common reason mentioned by patients for refusing to be reoriented. Conclusion: Reorientation to medical clinics using a new computer-based algorithm was safe and no case of urgent return was seen during the 6-month study period. In addition, patients who were reoriented to medical clinics were satisfied by their treatment experience.

scholarly journals Impact of bridging thrombolysis on clinical outcome in stroke patients undergoing endovascular thrombectomy: a retrospective analysis of a regional stroke registry

2020 ◽  
Author(s):  
Fatih Seker ◽  
Susanne Bonekamp ◽  
Susanne Rode ◽  
Sonja Hyrenbach ◽  
Martin Bendszus ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Hospital Mortality ◽  
Intracranial Hemorrhage ◽  
Stroke Patients ◽  
Short Term ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Good Outcome ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Impact

Abstract Purpose It is unclear whether stroke patients undergoing endovascular thrombectomy (EVT) should receive bridging intravenous thrombolysis (IVT), if eligible. This study aims at analyzing the impact of bridging IVT on short-term clinical outcome. Methods In a prospective regional stroke registry, all stroke patients with premorbid modified Rankin Scale (mRS) score of 0–2 who were admitted within 4.5 h after onset and treated with EVT were analyzed retrospectively. Patients receiving “IVT prior to EVT” (IVEVT) were compared to those undergoing “EVT only” regarding the ratio of good outcome, discharge mRS, mRS shift, hospital mortality, and occurrence of symptomatic intracranial hemorrhage. Results In total, 2022 patients were included, 816 patients (40.4%) achieved good clinical outcome; 1293 patients (63.9%) received bridging IVT. There was no significant difference between both groups regarding the ratio of good outcome (IVEVT 41.4% vs. EVT 38.5%, P = 0.231), discharge mRS (median, IVEVT 3 vs. EVT 3, P = 0.178), mRS shift (median, IVEVT 3 vs. EVT 3, P = 0.960), and hospital mortality (IVEVT 19.3% vs. EVT 19.5%, P = 0.984). Bridging IVT was not a predictor of outcome (adjusted OR 1.00, 95% CI 0.79–1.26, P = 0.979). However, it was an independent predictor of symptomatic intracranial hemorrhage (adjusted OR 1.79, 95% CI 1.21–2.72, P = 0.005). Conclusions The results of the present study suggest that bridging IVT does not seem to improve short-term clinical outcome of patients undergoing EVT. Nonetheless, there might be a subgroup of patients that benefits from IVT. This needs to be addressed in randomized controlled trials.

SELF- ADMINISTERED MEDICAL ABORTION PILLS AND ITS IMPACT ON WOMEN HEALTH

2021 ◽  
pp. 6-7
Author(s):  
Preety Soni ◽  
Ruchi Prasad
Keyword(s):  
Health Centre ◽  
Care Facility ◽  
Health Care Facility ◽  
Medical Abortion ◽  
Blood Transfusions ◽  
Surgical Interventions ◽  
Medical College ◽  
Women Health ◽  
Number Of Patients ◽  
The Impact

Objectives-This study is carried out to see the impact on women's health after self-administering medical abortion pill and reporting to tertiary health centre. Methodology- This is an observational study conducted between March 2019 to March 2021 in Patna Medical College and Hospitals. This study only included the women who self- administered the medical abortion pills without prior doctor consultation and visited the hospital with complications. Total of 120 patients were included in this study and analysis was done for age of patients, clinical presentations, ultrasound ndings etc. An analysis of maternal morbidity was done with respect to surgical interventions, blood transfusions and ICU admissions. Observation- In this study the maximum number of patients were in age group of 26-30 years. The commonest presentation is bleeding per vaginum which was seen in 60.8% of patients. In 67.5% of patients the incomplete abortion is the commonest ultrasound ndings. The most common complication was anaemia requiring blood transfusions. Conclusion-This study shows the need of supervision regarding the administration of medical abortion pills. This drug should be made available via health care facility.

Abstract W P57: Thrombolytic Therapy in Patients With Mild Stroke: An Observational Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jose G Romano ◽  
Eric E Smith ◽  
Li Liang ◽  
Hannah Gardener ◽  
Sara Camp ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Hospital Death ◽  
Stroke Patients ◽  
Short Term ◽  
Stroke Registry ◽  
Symptomatic Intracranial Hemorrhage ◽  
Mild Stroke ◽  
Independent Ambulation ◽  
Get With The Guidelines

Objective: Mild stroke has traditionally been excluded from thrombolytic treatment trials and only few series have reported outcomes after IV rtPA in this group. The objectives of this study are to determine the proportion of mild stroke patients treated with IV rtPA and evaluate complications and short-term outcomes in this population. Methods: We analyzed patients in the Get With The Guidelines-Stroke registry that arrived within 4.5 hours from symptom onset with a mild ischemic stroke defined as a baseline NIHSS ≤5 who received IV rtPA between May 2010 and October 2012. The following outcomes and complications were analyzed: in-hospital mortality, home discharge, independent ambulation, length of stay (LOS), in-hospital death, and symptomatic intracranial hemorrhage (sICH) <36 h. Multivariable analysis was performed for predictors of outcomes and complications. Results: Of 147,917 patients who arrived <4.5 hours, 39,821 were treated with IV rtPA, of whom 8,243 (20.7%) had an NIHSS ≤5. We analyzed 5,910 treated patients with NIHSS ≤5 and complete data. The mean baseline NIHSS was 3.5 (median 4); 98.2% arrived within 3 hours and 78.6% were treated within 3 hours. Outcomes and predictors of worse outcome are described in the table. There was no difference in short-term outcomes amongst those treated at 0-3 vs. 3-4.5 hours. Conclusions: A sizeable minority of ischemic stroke patients treated with IV rtPA have a NIHSS ≤5. sICH occurred at a low rate of 1.8% and about 30% of these patients were unable to return home and could not ambulate independently. Longer-term outcomes are needed to define predictors of poor outcome in this population and which patients may benefit most from treatment.

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