Abstract P838: Stroke Center Certification of a Community Hospital Results in Six Fold Increase in Thrombolytic Treatment for Stroke

Introduction: Prior studies that have demonstrated improved quality metrics after stroke certification often have added new neurological services to become certified. We aimed to evaluate the changes in volume of acute stroke/TIA and thrombolytic treatments in a hospital that underwent Primary Stroke Certification after seven years of established inpatient neurology and telestroke support. Methods: A retrospective analysis of prospectively collected data was completed from a community hospital. Data included 20 months prior to stroke certification (including 12 months with a stroke coordinator) and 17 months after certification. Annualized thrombolytic treatment and total stroke/TIA admissions were reviewed. Mann Whitney tests were used to determine if thrombolytic treatment, patients identified for mechanical stroke thrombectomy (MST), or both [total acute ischemic stroke (AIS) treatment] and total stroke/TIA volume per month differed before and after stroke certification. A subgroup analysis used a Mann Whitney to determine if the addition of a stroke coordinator during preparation for certification affected outcome metrics. Results: The hospital admitted 677 stroke/TIA patients during the study period, 230 before (82 without a stroke coordinator, 148 with a stroke coordinator) and 447 after stroke certification. Thrombolytic treatment increased from 2.4 patients per year prior to certification and 14.8 patients per year after stroke certification. The following outcome variables were increased after certification: thrombolytic treatments (1 vs. 0, p<0.001), patients identified for MST (1 vs. 0, p=0.001), total AIS treatments (1 vs. 0, p<0.001) and total stroke/TIA volume (27 vs. 11, p<0.001). Subgroup analysis suggested that preparation with a stroke coordinator was associated with increases in total AIS treatments (p=0.04) and telestroke requests (p=0.04); however, no differences in total stroke/TIA volume (p=0.18), thrombolytic treatments (p=0.08) or MST (p=0.41) were appreciated in absence of stroke coordinator. Conclusions: We found significantly increased rates of thrombolytic treatments, total stroke/TIA volume and patients identified for MST in a community hospital after primary stroke certification.

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The impact of establishing a stroke center at a community hospital on the use of thrombolytic therapy: the NINDS-Suburban Hospital Stroke Center experience

Stroke ◽

10.1161/str.32.suppl_1.374-b ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 374-374

Author(s):

Susan Unipan Rodriguez ◽

Thomas DeGraba ◽

Theresa Hamm ◽

Paul Nyquist ◽

John Hallenbeck ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Community Hospital ◽

Care Pathway ◽

Fold Increase ◽

Patient Characteristics ◽

Initial Screening ◽

Screening Criteria ◽

Stroke Center ◽

The Impact

P192 Background: One strategy that has been advocated to increase the percentage of stroke patients treated with thrombolytic therapy is the establishment of primary stroke centers in community hospitals. Methods: A stroke center was established at a 397-bed private community hospital in Bethesda, Maryland consistent with published recommendations (M. Alberts, et al, JAMA. 2000;283:3102). Following a 4 month pilot phase during which the stroke critical care pathway was introduced into hospital practice, around the clock coverage by the on-call stroke team was initiated on January 3, 2000. According to the pathway, the team was to be paged for any patient identified with a suspected new stroke and persistent deficits of less than 6 hours in duration (initial screening criteria). Observations of patient characteristics and times of key points in acute management are reported through July, 2000. Results: Sixty-four patients met the initial screening criteria (58 of these patients arrived at the hospital within 3 hours of onset of symptoms). Time in minutes to action (patient arrival at hospital to paging of neurologist, to arrival of neurologist, to scan) decreased over the first 7 months of stroke coverage (24 to 12, 28 to 16, 52 to 32, respectively, per 2-month average). Of 143 patients hospitalized with ischemic stroke during this period, 15 patients (10%) were treated with t-PA (10 IV, 5 IA). For the IV-treated patients, the median time to treat was 130 minutes and median door to needle time was 83 minutes, in line with benchmark values. During the same 7-month period of the year prior to the center initiation, only 3 patients were treated with t-PA at this hospital. Conclusions: A 5-fold increase in t-PA usage was observed in the first 7 months following the establishment of the stroke center (3-fold increase for IV t-PA use only). Establishment of a stroke center at a community hospital is feasible. Our experience to date suggests that a substantial increase in the frequency of patients receiving t-PA therapy for ischemic stroke may be achievable shortly after initiation of a community hospital stroke center.

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Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽

10.1161/str.52.suppl_1.p850 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Betty A McGee ◽

Melissa Stephenson

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Median Time ◽

Survival Data ◽

Stroke Patients ◽

Eligibility Criteria ◽

Before And After ◽

Administration Time ◽

System Data ◽

The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

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

Stroke ◽

10.1161/str.45.suppl_1.tp267 ◽

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.

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Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

Journal of brain disease ◽

10.4137/jcnsd.s2221 ◽

2009 ◽

Vol 1 ◽

pp. JCNSD.S2221

Author(s):

Byron R. Spencer ◽

Omar M. Khan ◽

Bentley J. Bobrow ◽

Bart M. Demaerschalk

Keyword(s):

Decision Making ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Onset ◽

Stroke Patients ◽

Emergency Medical ◽

Field Assessment ◽

Primary Stroke Center ◽

Stroke Center

Background Emergency Medical Services (EMS) is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC) relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA). Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED) arrival, recordings of time of stroke onset, blood pressure (BP), heart rate (HR), cardiac rhythm, blood glucose (BG), Glasgow Coma Scale (GCS), Cincinnati Stroke Scale (CSS) elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared to be very good overall. Diagnostic accuracy was excellent, field assessment, decision-making, and transport times were very good. There was still room for improvement in documentation of stroke onset and in employment of a common term for acute stroke.

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Abstract W P298: Simulation Based Acute Stroke Training for Neurology Residents

Stroke ◽

10.1161/str.46.suppl_1.wp298 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Deependra Khanal ◽

Sara Hocker

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Teaching Hospitals ◽

Self Confidence ◽

Emergency Department Nurse ◽

Simulation Based ◽

Before And After ◽

Tomography Scan ◽

Normal Head

Background: The majority of patients presenting with acute stroke in teaching hospitals are assessed by neurology residents. Simulation based training has been shown to be an effective teaching tool in medical education. We sought to determine whether simulation based training improves learner confidence in the evaluation and management of acute ischemic stroke. Methods: We devised a simulated acute stroke scenario utilizing a standardized patient instructed to act out a right hemispheric syndrome and an emergency department nurse. Scenarios were performed in May/June of 2013 and April/May of 2014. Laboratory values, vitals, electrocardiogram and a normal head computerized tomography scan were shown to the residents. Residents were expected to efficiently take a focused history, perform an NIHSS exam, evaluate exclusion and inclusion criteria, obtain informed consent for thrombolysis administration and give the correct dose of t-PA. Following t-PA administration, the patient develops an acute severe headache and the learner is evaluated on whether they immediately discontinue the infusion and initiate appropriate management steps for t-PA associated hemorrhage. Following the scenario the learner met one on one with staff for a debriefing session. Learner confidence in the management of acute stroke was assessed before and after the simulation experience using a 5 point Likert scale with 1=novice, 3=competent and 5=expert. Following the simulation, learners were asked to evaluate the experience (poor, needs improvement, good or outstanding). Results: 21 Neurology residents completed the scenario (11 in 2013 and 10 in 2014). Learner confidence improved from mean 2.81(SD-0.88) to 3.36(SD-0.73), p=0.03. Evaluations were favorable with all residents reporting a ‘good’ or ‘outstanding’ experience. Conclusion: We have demonstrated that simulation training in the evaluation of acute ischemic stroke among neurology residents is feasible and improves learner self-confidence.

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Abstract 196: Thrombolytic Treatment using Drip and Ship Treatment Paradigm among Acute Ischemic Stroke Patients in the United States: Outcomes and impact on regional thrombolytic utilization and referral patterns

Stroke ◽

10.1161/str.43.suppl_1.a196 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Wondwossen G Tekle ◽

Saqib A Chaudhry ◽

Habib Qaiser ◽

Ameer E Hassan ◽

Gustavo J Rodriguez ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

The United States ◽

Thrombolytic Treatment ◽

Stroke Patients ◽

Referral Patterns ◽

Hospital Outcomes ◽

Treatment Paradigm

Background: While single center and regional estimates of thrombolytic administration using drip and ship treatment paradigm are available, patient outcomes, thrombolytic utilization, cost, and referral patterns has not been assessed in United States. Objective: To provide national estimates of patients treated with thrombolytics using drip and ship paradigm and determine the impact of drip and ship treatment on regional thrombolytic utilization, treatment cost, and referral patterns of acute stroke patients in a large cohort. Methods: We determined the proportion of patients treated with drip and ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment and obtained comparative in-hospital outcomes from the Nationwide Inpatient Survey (NIS) data files from October 2008 to December 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Thrombolytic utilization, hospitalization cost, and patterns of referral related to drip and ship treatment of acute stroke were estimated. Results: Of the 26,814 ischemic stroke patients who received thrombolytic treatment, 5144 (19%) were treated using drip and ship paradigm. Seventy nine percent of all the drip and ship treated patients were referred to urban teaching hospitals for further care, and 7% of them received follow up endovascular treatment at the referral facility. States with higher proportion of patients treated using the drip and ship paradigm had higher rates of thrombolytic utilization (3.1% vs. 2.4%, p<0.001). After adjusting for age, gender, presence of hypertension, diabetes mellitus, renal failure, and hospital teaching status, outcomes of patients treated with drip and ship paradigm was similar to those who received thrombolytic and stayed in the same facility: self care (odds ratio [OR], 1.055, 95% confidence interval [CI], 0.910-1.224, p=0.4779); death(OR , 0.821 95% CI, 0.619- 1.088, p=0.1688); and nursing home discharge (OR, 1.023, 95% CI, 0.880- 1.189, p=0.7659) at discharge. Drip and ship paradigm was associated with shorter hospital stay (mean [days, SE] 5.9± 0.18 vs. 7.4 ± 0.15, p<0.001), and lower cost of hospitalization (mean total charges [$, SE) 57,000 ± 3,324 vs. 83,000 ± 3,367, p<0.001). Conclusions: One out of every five patients who received thromboytic treatment in United States is currently treated using drip and ship paradigm with comparable adjusted rates of favorable outcomes. There was a higher rates of thrombolytic utilization in States where drip and ship was more commonly implemented.

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Abstract 3251: Relationship Between tPA and Factor VIII Levels in Patients with Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a3251 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Tiffany R Chang ◽

Karen C Albright ◽

Rebecca Kruse-Jarres ◽

Cindy Lessinger ◽

Amelia K Boehme ◽

...

Keyword(s):

Ischemic Stroke ◽

Factor Viii ◽

Acute Ischemic Stroke ◽

Surrogate Marker ◽

Factor Viii Level ◽

Before And After ◽

Viii Level ◽

The Mean ◽

Stroke Center ◽

Iv Tpa

Background: Factor VIII levels may be screened as part of a hypercoagulable work-up in patients with ischemic stroke. However, it is unknown how treatment with IV tPA may affect these levels during the acute phase of ischemic stroke. Methods: From our prospective registry, we identified patients who presented with acute ischemic stroke to our stroke center between July 2008 and April 2011 and determined if factor VIII levels had been measured during the acute hospitalization. We compared mean factor VIII levels using independent sample t test in patients not treated with IV tPA to post-tPA treatment levels using independent samples t tests. Results: Of the 72 patients who had factor VIII levels checked during admission, 25 (34.7%) received IV tPA. The mean factor VIII level was observed to be lower in patients who were treated with tPA (140.8 vs 180.5, p=0.048). Patients who experienced averted stroke (36%, 9/25) had significantly lower mean factor VIII level than patients who completed infarction on diffusion-weighted MRI (64%, 16/25) (132.7 vs 175.2, p=0.002). Of patients with post-tPA factor VIII levels, the mean factor VIII level of those whose samples were drawn within 24 hours of tPA were not different than the mean factor VIII level of those whose samples were drawn more than 24 hours after tPA (p=0.784). Conclusion: Our observations found that factor VIII levels were lower in both patients treated with IV tPA and in patients with averted stroke. As factor VIII levels were drawn after thrombolytic therapy was administered, this raises the question of whether tPA lowers factor VIII levels or if factor VIII can serve as a potential surrogate marker for recanalization. Prospective studies examining factor VIII levels (1) before and after treatment with IV tPA and (2) in comparison to recanalization are needed to clarify this interesting observation.

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Extension of Public Smoking Ban Was Not Associated with Any Immediate Effect on Stroke Occurrence in Finland

Journal of Clinical Medicine ◽

10.3390/jcm10102060 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2060

Author(s):

Jussi O. T. Sipilä ◽

Jori O. Ruuskanen ◽

Jussi P. Posti ◽

Päivi Rautava ◽

Ville Kytö

Keyword(s):

At Risk ◽

Ischemic Stroke ◽

Subarachnoid Hemorrhage ◽

Intracerebral Hemorrhage ◽

Acute Stroke ◽

Negative Binomial ◽

Negative Binomial Regression ◽

Smoking Ban ◽

Binomial Regression ◽

Before And After

We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One annual admission per patient was included. Negative binomial regression accounting for the at-risk population was applied. We found no difference in stroke occurrence before and after the smoking ban within 7 days (p = 0.217), 30 days (p = 0.176), or the whole study period (p = 0.998). Results were comparable for all stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). There was no sign of decreased occurrence in June 2007 compared to June in 2005–2006, and all subtypes of stroke occurred at least as frequently in both May and June of 2008 as in May and June of 2007. In conclusion, the nationwide restaurant smoking ban Finland enacted in June 2007 was not associated with any immediate reduction in stroke occurrence.

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EXPRESS: Impact of Stroke Center Certification on rt-PA Thrombolysis after Acute Ischemic Stroke in South China from 2015 to 2020

International Journal of Stroke ◽

10.1177/17474930211031440 ◽

2021 ◽

pp. 174749302110314

Author(s):

Yicong Chen ◽

Jiaoxing Li ◽

Chao Dang ◽

Shuangquan Tan ◽

Fubing Ouyang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

South China ◽

Intravenous Thrombolysis ◽

Recombinant Tissue Plasminogen Activator ◽

Number Of Patients ◽

Tissue Plasminogen ◽

Before And After ◽

Stroke Center ◽

The City

Background and purpose: In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. Methods: We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke (AIS) within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearmanâs correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke center. Results: From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers were higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55 %/y vs. 0.77 %/y, P < 0.001). Conclusions: Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with AIS.

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Pilot study of volume contracted state and hospital outcome after stroke

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000419 ◽

2018 ◽

Vol 8 (1) ◽

pp. 21-26 ◽

Cited By ~ 3

Author(s):

Mona N. Bahouth ◽

Andrew Gaddis ◽

Argye E. Hillis ◽

Rebecca F. Gottesman

Keyword(s):

Ischemic Stroke ◽

Infarct Size ◽

Acute Stroke ◽

Urine Specific Gravity ◽

Consecutive Series ◽

Stroke Patients ◽

Multivariable Analyses ◽

Stroke Center ◽

Time Of Admission ◽

The Relationship

BackgroundAn increasing body of research suggests that acute stroke patients who are dehydrated may have worsened functional outcomes. We sought to explore the relationship between a volume contracted state (VCS) at the time of ischemic stroke and hospital outcomes as compared with euvolemic patients.MethodsWe enrolled a consecutive series of ischemic stroke patients from a single academic stroke center within 12 hours from stroke onset. VCS was defined via surrogate markers (blood urea nitrogen/creatinine ratio >15 and urine specific gravity >1.010). The primary outcome was change in NIH Stroke Scale (NIHSS) score from admission to discharge. Multivariable analyses included adjustment for demographics and infarct size.ResultsOver an 11-month study period, 168 patients were eligible for inclusion. Of the126 with complete laboratory and MRI data, 44% were in a VCS at the time of admission. Demographics were similar in both the VCS and euvolemic groups, as were baseline NIHSS scores (6.7 vs 7.3; p = 0.63) and infarct volumes (12 vs 16 mL; p = 0.48). However, 42% of patients in a VCS demonstrated early clinical worsening, compared with 17% of the euvolemic group (p = 0.02). A VCS remained a significant predictor of worsening NIHSS in adjusted models (odds ratio 4.34; 95% confidence interval 1.75–10.76).ConclusionsAcute stroke patients in a VCS demonstrate worse short-term outcomes compared to euvolemic patients, independent of infarct size. Results suggest an opportunity to explore current hydration practices.

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