Abstract WP433: Factor Associated With Significant Delay in Acute Stroke Triage Process

Background: Benefit of revascularization in acute ischemic stroke declines over time. Any delay in acute stroke care contributes to poor treatment outcome. We aimed to identify factors associated with the delay in the process of acute stroke triage. Methods: All patients presented at the emergency room at the Siriraj Hospital, Mahidol University, Thailand under stroke fast track protocol (ASFP) from January 2015 to March 2017 were reviewed. Demographic data, stroke subtypes, time measures, initial NIHSS were recorded. Delay in triage was defined as either door to first physician > 10 minutes or door to activate stroke fast track > 15 minutes. Multivariable logistic regression model were performed to identify independent variables associated with triage delay. Results: A total of 1,000 patients were enrolled under ASFP with a mean age of 63.5+15.3 years and 53.9% were male. Triage delay was found in 11.2%. Factors associated with a delay in stroke triage were inaccurate presenting symptom(s) OR17.69 (95% CI 10.86, 28.82), dizziness and dysphagia as an initial presentation OR 3.26 (95% CI 1.64, 6.48) and OR 8.02 (95% CI 1.31, 49.28) respectively and uncertain chief complaint OR 3.35 (95% CI 1.56, 7.19). Conclusion: Unclear chief complaint, dizziness and vertigo as an initial symptoms and inaccurate presenting symptoms significantly associated with the delay in acute stroke triage in an emergency department. Further research is needed to clarify if strategic questioning could help nurses and ER physicians in reducing this delay.

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Abstract MP22: Sex Differences in the Delivery of Acute Telestroke Care

Stroke ◽

10.1161/str.52.suppl_1.mp22 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Johanna L Morton ◽

Suraj Didwania ◽

Eric Anderson ◽

Jason Hallock

Keyword(s):

Sex Differences ◽

Ischemic Stroke ◽

Acute Stroke ◽

Patient Population ◽

Functional Outcomes ◽

Stroke Care ◽

Stroke Severity ◽

Acute Stroke Care ◽

Presenting Symptoms ◽

Suspected Stroke

Background: Sex differences are encountered in many aspects of ischemic stroke, including risk factors, presenting symptoms, stroke mechanism, acute interventions and functional outcomes. As telestroke services continue to expand, many patients utilize telestroke for the evaluation and treatment of suspected stroke symptoms. To date, the existence of such differences between sexes has not been identified in the patient population having utilized telestroke for acute stroke care. Methods: A retrospective observational study of the experience of a single teleneurology practice serving 340 hospitals from April 2018 to June 2020 was performed. Patients seen in the emergency department (ED) with a diagnosis of suspected stroke were included. Data from the acute stroke encounter was reported through the current medical record platform. Results: Within the queried period, there were 11,454 male and 11,794 female patients identified as having received ED telestroke evaluation for suspected acute stroke. Males were younger than females (67 vs 70, P <0.01). Males had higher rates of prior stroke, hypertension, diabetes, hyperlipidemia, and coronary disease than females ( P <0.01), while females had higher rates of atrial fibrillation ( P =0.03) and TIA ( P <0.01). Rates of antiplatelet and anticoagulants were higher in males ( P <0.01) than females. There were no differences in time to ED presentation, time to request consult or make a thrombolysis decision, or length of consult. Females had higher stroke severity ( P <0.01) and door-to-needle times ( P <0.01), but lower alteplase rates ( P =0.02) compared to males. Conclusion: This review of a national heterogeneous telestroke patient population is indicative of sex differences in multiple aspects of acute ischemic stroke, most notably in thrombolysis delivered via telestroke. Further investigation into the etiology of such differences is warranted, as well as a survey of functional outcomes. As telemedicine continues to expand in the era of the COVID-19 pandemic, it is imperative that the reasons behind this disparity are investigated.

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Factors Associated with Shortening of Prehospital Delay among Patients with Acute Ischemic Stroke

Journal of Clinical Medicine ◽

10.3390/jcm8101712 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1712 ◽

Cited By ~ 5

Author(s):

Raúl Soto-Cámara ◽

Josefa González-Santos ◽

Jerónimo González-Bernal ◽

Asunción Martín-Santidrian ◽

Esther Cubo ◽

...

Keyword(s):

Acute Stroke ◽

Public Awareness ◽

Stroke Care ◽

University Hospital ◽

Medical Emergency ◽

Acute Stroke Care ◽

Cross Sectional ◽

Factors Associated ◽

Prehospital Delay ◽

Awareness Campaigns

Background: Despite recent advances in acute stroke care, only 1–8% of patients can receive reperfusion therapies, mainly because of prehospital delay (PHD). Objective: This study aimed to identify factors associated with PHD from the onset of acute stroke symptoms until arrival at the hospital. Methods: A cross-sectional study was conducted including all patients consecutively admitted with stroke symptoms to Burgos University Hospital (Burgos, Spain). Socio-demographic, clinical, behavioral, cognitive, and contextualized characteristics were recorded, and their possible associations with PHD were studied using univariate and multivariable regression analyses. Results: The median PHD of 322 patients was 138.50 min. The following factors decreased the PHD and time until reperfusion treatment where applicable: asking for help immediately after the onset of symptoms (OR 10.36; 95% confidence interval (CI) 4.47–23.99), onset of stroke during the daytime (OR 7.73; 95% CI 3.09–19.34) and the weekend (OR 2.64; 95% CI 1.19–5.85), occurrence of stroke outside the home (OR 7.09; 95% CI 1.97–25.55), using a prenotification system (OR 6.46; 95% CI 1.71–8.39), patient’s perception of being unable to control symptoms without assistance (OR 5.14; 95% CI 2.60–10.16), previous knowledge of stroke as a medical emergency (OR 3.20; 95% CI 1.38–7.40), call to emergency medical services as the first medical contact (OR 2.77; 95% CI 1.32–5.88), speech/language difficulties experienced by the patient (OR 2.21; 95% CI 1.16–4.36), and the identification of stroke symptoms by the patient (OR 1.98; 95% CI 1.03–3.82). Conclusions: The interval between the onset of symptoms and arrival at the hospital depends on certain contextual, cognitive, and behavioral factors, all of which should be considered when planning future public awareness campaigns.

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Abstract 99: Geographic Access to Acute Stroke Care in the United States

Stroke ◽

10.1161/str.45.suppl_1.99 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Opeolu Adeoye ◽

Brendan G Carr ◽

Karen C Albright ◽

Catherine Wolff ◽

Michael Mullen ◽

...

Keyword(s):

Acute Stroke ◽

Response Times ◽

Demographic Data ◽

Stroke Care ◽

The United States ◽

Fee For Service ◽

Acute Stroke Care ◽

Geographic Access ◽

The Us ◽

Iv Tpa

Background: Only 5% of ischemic stroke (IS) patients receive IV tPA and less than 1% receive endovascular therapy (ET). Prior work has described access to Primary Stroke Centers (PSC). We describe access of the US population to all facilities that provide IV tPA or ET for IS. Methods: We used US demographic data and IV tPA and ET rates in the 2011 Medicare Provider and Analysis Review (MEDPAR), a claims-based dataset that contains fee-for-service Medicare-eligible inpatient hospital discharges in the US. ICD-9 codes 433.xx, 434.xx and 436 identified IS cases. ICD-9 code 99.10 defined IV tPA treatment. Among IS cases, hospitals that gave any IV tPA were considered IV capable. ET was defined by ICD-9 code 39.74. Hospitals that performed any ET in IS cases were considered endovascular capable. PSCs were defined as hospitals certified as such by the Joint Commission in 2010. We estimated ambulance response times using arc-GIS’s network analyst and helicopter transport times using validated models. Population access to care was determined by summing the population contained within travelsheds that could reach capable hospitals within 60minutes. Results: Of 370351 IS primary diagnosis discharges, 14926 (4%) received IV tPA and 1889 (0.5%) had ET. By ground, 81% percent of the US population had access to IV capable hospitals within 60minutes, 66% had access to PSCs and 56% had access to ET capable hospitals. By air, 97% percent had access to IV capable hospitals within 60minutes, 91% had access to PSCs and 85% had access to ET hospitals. The Figure shows 60 (yellow) and 120 minute (green) access to IV rt-PA capable hospitals. Conclusion: Most of the US population has geographic access to acute stroke care, but treatment rates remain extremely low. Given our definitions of capability, actual access may be less than described. To optimize US stroke care systems and increase the use of acute therapies, pre- and inhospital interventions to overcome barriers in access to acute stroke care are needed.

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Berlin PRehospital Or Usual Delivery of Acute Stroke Care 2.0 (B_PROUD 2.0)

Case Medical Research ◽

10.31525/ct1-nct03931616 ◽

2019 ◽

Author(s):

Keyword(s):

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care

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Essential Acute Stroke Care in Low Resource Settings: a Pilot studY

Case Medical Research ◽

10.31525/ct1-nct04157231 ◽

2019 ◽

Author(s):

Keyword(s):

Pilot Study ◽

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care ◽

Low Resource Settings ◽

Low Resource

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Faculty Opinions recommendation of Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8785964.9312066 ◽

2011 ◽

Author(s):

Erik Buskens

Keyword(s):

Prospective Study ◽

Acute Stroke ◽

Associated Factors ◽

Stroke Care ◽

The South ◽

Acute Stroke Care ◽

Multiethnic Population ◽

Stroke Register

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Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

Cerebrovascular Diseases ◽

10.1159/000516309 ◽

2021 ◽

pp. 1-9

Author(s):

Anna Ramos-Pachón ◽

Álvaro García-Tornel ◽

Mònica Millán ◽

Marc Ribó ◽

Sergi Amaro ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Stroke Care ◽

Care Quality ◽

Point Of View ◽

Stroke Severity ◽

Acute Stroke Care ◽

Vessel Occlusion ◽

Prehospital Delays ◽

The Impact

Introduction: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. Methods: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. Results: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], p 0.015) during the pandemic period. Conclusion: During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

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Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

Cerebrovascular Diseases ◽

10.1159/000514140 ◽

2021 ◽

pp. 1-7

Author(s):

Gabriel Velilla-Alonso ◽

Andrés García-Pastor ◽

Ángela Rodríguez-López ◽

Ana Gómez-Roldós ◽

Antonio Sánchez-Soblechero ◽

...

Keyword(s):

Elderly Patients ◽

Acute Stroke ◽

Time Course ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Acute Stroke Care ◽

Group Data ◽

Radiological Data ◽

History Of ◽

Prehospital Delays

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the COVID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

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