Abstract P364: Use of the Electronic Alberta Stroke Program Early CT Score Software to Guide Treatment of Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Danielle L Weiss ◽  
Dennis Y Chuang ◽  
Ali Fadhil ◽  
Kelsey R Duncan ◽  
Alexa Weiss ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Community Hospitals ◽  
Ct Head ◽  
Logistic Regressions ◽  
Transferred Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Contrast Ct ◽  
The Relationship

Introduction: Rapid recognition of large-vessel middle cerebral artery (lvMCA) stroke in patients with acute stroke symptoms is critical to guide thrombectomy and hemicraniectomy decisions. The Electronic Alberta Stroke Program Early CT Score (e-ASPECTS; Brainomix, LLC) is an automated, artificial intelligence software which quantifies acute ischemic volume (AIV) on CT head scans in the MCA territory. In this study, we investigate if e-ASPECTS-derived AIV could help guide treatment and predict outcomes for patients transferred from community hospitals. Hypothesis: E-ASPECTS can help identify patients that may benefit from thrombectomy or hemicraniectomy. Methods: We performed a retrospective chart review on patients age 18-90 transferred to our comprehensive stroke center (CSC) between 2013-2017. Non-contrast CT head scans performed at community hospitals prior to transfer were processed by e-ASPECTS to calculate AIV. Logistic regressions were used to test the relationship between AIV and eventual treatment (thrombectomy, hemicraniectomy). Results: 228 patient CT scans were analyzed by e-ASPECTS. In all transferred patients, higher AIV predicted patients with later confirmed lvMCA strokes (defined as an ICA or M1 occlusion; OR 1.03, CI 1.02-1.05, P<0.001). Higher AIV also trended toward thrombectomy but was not statistically significant (P=0.15). In the subgroup analysis of patients later confirmed to have lvMCA strokes, lower AIV was predictive for thrombectomy (OR 0.95, CI 0.92-0.97, P<0.001). Additionally, higher AIV predicted outcomes of malignant cerebral edema (MCE; OR 1.03, CI 1.02-1.05, P<0.001) and hemicraniectomy (OR 1.04, CI 1.00-1.07, P=0.03). Conclusions: Our study suggests that e-ASPECTS may be useful in identifying patients who would, or would not, benefit from transfer to a CSC from hospitals without thrombectomy or hemicraniectomy resources. Patients with stroke mimics or lvMCA strokes with large penumbras have lower AIVs, while patients with higher AIVs are at risk for MCE and may benefit from hemicraniectomy.

scholarly journals Ocular, Neurologic and Systemic Findings of the Cases with Optic Nerve Hypoplasia

2016 ◽  
Vol 10 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Eyyup Karahan ◽  
Ayse Tulin Berk
Keyword(s):  
Optic Nerve ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Optic Nerve Hypoplasia ◽  
Refractive Errors ◽  
Poor Vision ◽  
The Relationship ◽  
The Brain ◽  
Ocular Signs ◽  
Neurologic Findings

Aim: To describe the associated ocular, neurologic, and systemic findings in a population of children with optic nerve hypoplasia (ONH) and to evaluate the relationship between ocular signs and neurologic findings. Method: A retrospective chart review of 53 patients with the diagnosis of ONH seen between December 1998 and September 2012 was performed. All neurodevelopmental anomalies, neuroradiologic findings, endocrinologic and systemic findings were recorded. Poor vision was defined as the visual acuity poorer than logMAR 1.0 or inadequate central steady maintained fixation. Results: Thirty (56.6%) of the 53 children with ONH were boys. Mean age at presentation was 56.2±46.8 months (range; 3 months to 18 years). Poor vision defined for the purpose of this study was found in 47.2% of 53 patients. Thirty-three (62.3%) children had nystagmus. Thirty-four (64.2%) children had strabismus. Thirteen (38.2%) of those with strabismus had esotropia, 20 (58.8%) had exotropia. The total number of the children with neurodevelopmental deficit was 22 (41.5%) in our study. Conclusion: The vision of young children with ONH should be monitored at least annually, and any refractive errors should be treated. Neuroimaging of the brain and endocrinologic evaluation is necessary in all cases with ONH.

Abstract TP373: Classification of sICH in Stroke Center Hospitals: Reliability in Question

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Victoria Swatzell ◽  
Fern Cudlip ◽  
Andrei V Alexandrov ◽  
Anne W Alexandrov
Keyword(s):  
Pay For Performance ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Quality Data ◽  
Treatment Rate ◽  
Team Members ◽  
Common Definition ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Contrast Ct

Background: Measuring sICH is an important accountability of Stroke Centers. Since the NINDS rt-PA Study, the sICH definition has changed as knowledge of reperfusion-associated hemorrhagic transformation has grown. We aimed to determine what sICH definition was used by Stroke Centers and how this impacts sICH rates. Methods: Stroke Centers were invited to participate in a survey with the option to complete it via SurveyMonkey TM or by mail. Instructions to adhere to the sICH definition adopted in policies/procedures were provided, and to ask for clarification from Stroke Team members if needed. Data were assembled in SPSS, and analyzed using descriptive statistics and Student t-tests. Results: 229 responses were received representing 84% of U.S. states and the District of Columbia; 31% represented academic medical centers and 69% community hospitals. 64% of respondees were responsible for collecting the stroke quality data that supports certification. Overall tPA treatment rate for the sample was 8.7% + 6.4 (median 7%), with an overall reported sICH rate of 9.5% + 16.4 (median 5%). Official definitions supported sICH for 86% of responding hospitals, however the most common definition (48%) reported was, “any hemorrhage on non-contrast CT or MRI in combination with any clinical deterioration.” Only 17% identified the definition for sICH adopted by TJC for Comprehensive Stroke Center reporting. Among those that adhered to the TJC definition, sICH rates were significantly lower at 3%+2.3 (median 3%; t=4.7; mean difference = 7.7%; p<.0001, 95% CI 4.4-10.95), compared to 10.6%+17.5 (median 6%). Conclusions: Our study documents a significant need for education and inter-rater reliability monitoring of the use of sICH classification after intravenous tPA to ensure accuracy in local quality improvement processes, as well as the validity of data submitted to national stroke registries. Additionally, because sICH associated with reperfusion therapy is a new measure undergoing testing by TJC that could ultimately be tied to future pay-for-performance and public reporting, consensus on its definition as well as reliable sICH classification will be essential to future Stroke Center evaluation.

Abstract WP65: Clinical and Radiographic Characterization of Cerebral Hyperdensities on Post-thrombectomy Conventional Non-contrast Ct Brain: Differentiating Between Contrast Staining and Post-thrombectomy Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hyung K Kang ◽  
Raffi Ourfalian ◽  
Emilie T Nguyen ◽  
Fernando A Torres ◽  
Lei T Feng ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Anterior Circulation ◽  
Chi Square ◽  
Imaging Characteristics ◽  
Increase Risk ◽  
Patient’S Outcome ◽  
Ct Brain ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Contrast Ct

Background: Post-interventional cerebral hyperdensities (PCHD) are present 31.2 to 87.5% of the time on post-thrombectomy (PT) CT. It can be difficult for radiologists to differentiate if PCHD represents intracerebral hemorrhage (ICH) or contrast staining using conventional CT. The ability to accurately determine the etiology of PCHD may be important for a patient’s outcome. Methods: We retrospectively investigated clinical risk factors, imaging findings, and interventional technique of patients who had a thrombectomy from 2011-2017 (n=238) at a Comprehensive Stroke Center. 112 patients with anterior circulation infarcts and immediate PT CTs as well as either a PT MRI or follow-up CT within 48 hours were included. Two experienced neuroradiologists interpreted all imaging. Baseline demographics and imaging characteristics were collected. The presence of ICH was determined by dephasing on gradient echo or by its persistence > 2 days on repeat CT. Chi-square and Fisher’s exact tests were used for statistical significance, and logistic regression to determine risk estimates. Results: 84% of patients had PCHD, of which 56% had ICH. Patients had similar demographics (ICH: median age 69, 47.5% female; non-ICH: median age 71, 42.5% female). Higher pre-thrombectomy ASPECTS score (OR 0.62, p < 0.05) decreased the risk of ICH, and higher Hounsfield units (HU) of PCHD both on immediate (OR 1.04, p < 0.05) and intermediate (OR 1.1, p < 0.0005) PT CT increased the risk of ICH. PCHDs in the deep grey matter (OR 2.84, p < 0.05) and demonstrating a confluent pattern (OR 3.9 p < 0.05) increased the likelihood of ICH. 10% increase risk of ICH was seen for every HU increase in density on PT CT at 24 or 48 hours. A 50% decrease in ICH was observed for each unit increase of the pre-thrombectomy ASPECTS score. ROC revealed the optimal cut-off for predicted probability as 0.64, sensitivity 70.2% and specificity 69.2%. The AUC for the predicted model was 0.84 (95%CI= (0.75- 0.92, p <0.0001). Conclusion: Several imaging characteristics of PCHDs and ASPECTS score can help differentiate between the PT ICH and contrast staining. Application of these variables to patients in the immediate PT period may change clinical management.

Abstract P404: Causes of Recrudescent Stroke Symptoms in Emergent Stroke Evaluations

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Quinn ◽  
Mohammad Hajighasemi ◽  
Laurie Paletz ◽  
Sonia Figueroa ◽  
Konrad Schlick
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Ischemic Lesion ◽  
Tertiary Care Medical Center ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Rule Out

Introduction: Recrudescent symptoms of remote central nervous system lesions (primarily due to prior ischemic or hemorrhagic stroke) is a specific stroke mimic that is commonly in the differential diagnosis in patients presenting for emergent stroke evaluation. To date, best practices have yet to be established in terms of ensuring accurate diagnosis and the relative rates of causative systemic illnesses are not well described. We seek to better delineate the etiologies of recrudescent stroke symptoms seen at a tertiary care medical center via emergency stroke evaluation “Code Brain” (CB) as a first step towards clarifying diagnostic criteria for this entity. Methods: Data was obtained via retrospective chart review from consecutive patients via departmental database listing all CB consults seen at a tertiary care comprehensive stroke center in Los Angeles, California between the timeframe of January 2018- June 2020. Diagnoses for each case were adjudicated by faculty Vascular neurologists, in collaboration with Vascular neurology fellows and Neurology residents. Those cases with a diagnosis of stroke recrudescence were reviewed in detail for the extent of neuroimaging they underwent, as well as for identified causes of recrudescence. Results: Records of 3,998 consecutive CB activations were reviewed. 2.1% (n=85) were found after screening to have clinical diagnosis of recrudescence or chronic stroke. Of these 85 patients, 29.4% (n=25) were not found to have a causative etiology for recrudescent neurologic deficit. Of these 25 patients, 36.0% (n=9) did not undergo MRI to evaluate for interval ischemic lesion, as compared to 46.6% of those whom a causative etiology was identified. This difference (10.6%, 95% CI -12.30 to 30.67%, p=0.3719) was not significant. Discussion: At our comprehensive stroke center, recrudescent stroke is an uncommon diagnosis amongst all CB evaluations, despite being commonly considered. Despite a diagnosis of recrudescence, MRI brain is not always performed to rule out acute ischemic stroke. Standardized neuroimaging protocols should be considered in making the diagnosis of stroke recrudescence.

Association between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds

2012 ◽  
Vol 49 (5) ◽  
pp. 735-749 ◽  
Author(s):  
Danni Li ◽  
Samuel Law ◽  
Lisa Andermann
Keyword(s):  
Ethnic Minority ◽  
Social Factors ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Social Defeat ◽  
Employment History ◽  
Level Of Education ◽  
Before And After ◽  
Psychosocial History ◽  
The Relationship

Immigrants have a heightened risk of developing schizophrenia, suggesting that social factors play an important role in the pathogenesis of schizophrenia. This study aimed to examine the relationship between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds. Retrospective chart review was conducted. Patients’ psychosocial history, particularly employment history, level of education, and subjective feelings of societal integration before and after immigration, were compared to determine the degree of social defeat. It was found that delusional themes of psychological persecution, such as control and reference, were more common in those with either moderate or severe degrees of social defeat.

scholarly journals Inappropriate Telemetry Use Is Increased during the COVID-19 Era

Healthcare ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1610
Author(s):  
Jean Kim ◽  
Kyle Miyazaki ◽  
Yoshito Nishimura ◽  
Ryan Honda
Keyword(s):  
Decision Making ◽  
Respiratory Failure ◽  
American Heart Association ◽  
Chart Review ◽  
American Heart ◽  
Clinical Care ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Academic Hospital ◽  
The Relationship

Due to the unprecedented COVID-19 pandemic, there may be overuse of telemetry monitoring compared to the pre-pandemic period. We compared the frequency of inappropriate telemetry use in the pre-COVID-19 period (1 November 2019 to 28 February 2020) versus the peri-COVID-19 period (1 March 2020 to 30 June 2020) at a major academic hospital in Honolulu, Hawaii, by a retrospective chart review to assess for the appropriateness of the telemetry orders during this period, based on the 2017 American College of Cardiology/American Heart Association guidelines. Compared to the pre-COVID-19 period, there was a significant increase in inappropriate telemetry use during the peri-COVID-19 period (X2 (1, N = 11,727) = 6.59, p = 0.0103). However, there was no increase in the proportions of respiratory failure (4.0%) or pneumonia (2.7%) during the peri-COVID-19 period. The increase in inappropriate telemetry use may be related to the uncertainty in clinical care and decision making amid the pandemic of the new virus. Appropriate utilization of telemetry monitoring is increasingly important during the pandemic due to the limited availability of resources. Further investigation is needed to clarify the relationship between the pandemic and trends in telemetry ordering.

Intelligence and academic achievement in inpatient adolescents with comorbid anxiety and depression

2021 ◽  
Vol 85 (1) ◽  
pp. 23-41
Author(s):  
Anna P. Schrack ◽  
Diana Joyce-Beaulieu ◽  
Jann W. MacInnes ◽  
John H. Kranzler ◽  
Brian A. Zaboski ◽  
...  
Keyword(s):  
Academic Achievement ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Academic Functioning ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Comorbid Depression ◽  
Comorbid Anxiety ◽  
Severity Of Depression ◽  
The Relationship

Few studies have investigated the relationship between comorbid depression and anxiety and cognitive and academic functioning. To understand this relationship, this study used a retrospective chart review from an inpatient facility for 42 adolescents diagnosed with a comorbid anxiety and depressive disorder. Multiple regression was used to determine whether anxiety and depression predicted academic achievement, as well as whether intelligence predicted current levels of anxiety and depression. Results indicated that higher severity of depression was associated with lower reading (β = –0.39) and writing (β = –0.40) achievement, while higher severity of anxiety was associated with higher scores on reading (β = 0.41) and writing (β = 0.36). Full-scale IQ was not significantly predictive of anxiety severity (β = 0.08) or depression severity (β = –0.24). Results are discussed in terms of identifying risk factors and improving outcomes for adolescents with severe comorbid anxiety and depression psychopathology.

Abstract 1122‐000175: Comparison of Transradial Artery Versus Transfemoral Artery Access Mechanical Thrombectomy at a Comprehensive Stroke Center

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Taha Nisar ◽  
Jimmy Patel ◽  
Amit Singla ◽  
Priyank Khandelwal
Keyword(s):  
Mechanical Thrombectomy ◽  
Retrospective Chart Review ◽  
Functional Independence ◽  
Binary Logistic Regression Analysis ◽  
Transfemoral Approach ◽  
Outcome Parameters ◽  
Significant Difference ◽  
First Pass ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction : The transradial approach (TRA) is being increasingly adopted by neuro‐interventionists and has emerged as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to compare various time, technical and outcome parameters in patients who undergo MT via TRF vs. TRA approach. Methods : We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2016 to 12/2020. We compared patients who underwent MT via TRA vs. TRF with respect to time from angio suite arrival to puncture, first pass, second pass and recanalization; time from puncture to first pass, second pass and recanalization; time from arrival to the emergency department (ED) to puncture, first pass, second pass and recanalization; the number of passes, rate of switching, achievement of TICI≥2b score, functional independence (3‐month mRS≤2), 3‐month mortality and neurological improvement (improvement in NIHSS by ≥4 points) on day 1 and 3. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, type of anesthesia (general vs. moderate), laterality, and location of clot (internal carotid or middle cerebral artery), ASPECTS≥6, presenting mean arterial pressure, blood glucose, Hb A1C, LDL, intravenous alteplase. Results : 217 patients met our inclusion criteria. The mean age was 64.09±14.4 years. 42 (19.35%) patients underwent MT through the TRA approach. There was a significantly higher rate of conversion from TRA approach to TRF approach (11.90% vs.2.28%; OR, 105.59; 95% CI,5.71‐1954.67; P 0.002), but no difference in various time, technical and outcome parameters, as shown in the table. Conclusions : Our study demonstrates no significant difference between TRA and TRF approaches with respect to various time, technical and outcome parameters, with a notable exception of a significantly higher rate of conversion from TRA to TRF approach.

Abstract TP391: Working Within a Stroke System of Care to Decrease Door to Transfer Times From Spoke to Hub

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle Whaley ◽  
Alissa Dell ◽  
Melissa Chase ◽  
Melissa Mooney ◽  
Jill Hulbert ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Best Practice ◽  
Retrospective Chart Review ◽  
Nurse Leaders ◽  
Study Objective ◽  
Team Members ◽  
Imaging Results ◽  
Number Of Patients ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Best practice recommends that hospitals treating acute stroke patients have protocols in place to ensure rapid transfer to an advanced facility for a higher level of care, if needed. Our system of hospitals consists of five primary stroke centers (PSC) and one comprehensive stroke center (CSC) in a major metropolitan area. PSCs utilize telemedicine for acute stroke decision-making and patients are transferred to the CSC for consideration of advanced treatments when deemed appropriate by the care team. Purpose: Our study objective was to streamline processes at our PSCs to decrease the door to transport time (DTT) to the CSC. Methods: Stroke coordinators from the six sister hospitals meet quarterly to collaborate and share best practices in patient care. Our team of nurse leaders determined potential strategies to eliminate wasted time in the transfer process. Team members went back to their home facilities with the goal of generating buy-in from individual caregivers to decrease the time to transport out to the CSC. An overall attitude of urgency was encouraged during meetings with stroke councils and providers. Preliminary imaging results were used to guide decision to transfer, rather than waiting for final results. Some hospitals chose to notify the flight team of potential transport earlier in the emergency department stay, while others are still in the process of affecting change. We collected data on transferred patients with a diagnosis of acute stroke between the dates of 2/1/15-7/31/15 (n=23) and compared against the same time period in 2014 (n=11). Results: A total of 34 patients were included in our retrospective chart review. The number of patients transferred for consideration of additional acute treatment increased from 11 in 2014 to 23 during the study period in 2015. When examining patients who transferred and actually received endovascular treatment for acute stroke (n=8 in 2014 versus n=11 in 2015), the mean DTT decreased from 84 minutes in 2014, to 77 minutes in 2015. We also noted that patient transfers were faster during day time hours when compared to night. Conclusions: A system-wide, collaborative approach between PSCs and CSCs can decrease DTT when nurse leaders and providers streamline processes.

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