Interpretation of CT Scans for Acute Stroke

ABSTRACT:Objective:To determine the effectiveness of an Acute Stroke Triage Pathway in reducing door to needle times in acute stroke treatment with IV t-PA.Background:A previous study at our tertiary referral centre, examining IV t-PA door to needle times, was completed in 2000. The median door to needle time was beyond the recommended National Institute for Neurological Disorders and Stroke (NINDS) standard of 60 minutes. In November 2001, an Acute Stroke Triage Pathway was introduced in the emergency room (ER) to address this issue. The goal of this pathway was to rapidly identify patients eligible for treatment for IV t-PA, so that CT scans and lab studies could be arranged immediately upon ER arrival. Our hypothesis was that the Triage Pathway would shorten door to CT and door to needle times.Design/Methods:Using retrospective data, pre (n=87) and post (n=47) triage pathway times were compared. The door to CT time was reduced by 11 minutes (p=0.015) and door to needle time was reduced by 18 minutes (p=0.0036) in a subgroup of patients that presented directly to our hospital.Conclusions:These results indicate that the Acute Stroke Triage Pathway is effective in reducing Door to CT and Door to Needle Times in patients presenting directly to our ER. However, a majority of treatment times were still beyond NINDS recommendations. Stroke Centers require periodic review of their efficiency to ensure that target times are being obtained and may benefit from the use of an Acute Stroke Triage Pathway.

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Abstract TP59: To Estimate the Time of Stroke Onset by Using Ct Scan and Stroke Severity Scale

Stroke ◽

10.1161/str.48.suppl_1.tp59 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Saadat Kamran ◽

Zain Bhutta ◽

Naveed Akhtar ◽

Vernice Bates ◽

Abdul Salam ◽

...

Keyword(s):

Acute Stroke ◽

Ct Scan ◽

False Positive ◽

False Negative ◽

Stroke Onset ◽

Ct Scans ◽

Time Range ◽

Stroke Patients ◽

Area Of Interest ◽

Number Of Patients

Purpose: Thrombolysis in acute stroke is time limited. Onset time is unknown in a large number of patients. We wanted to classify acute stroke patients with unknown time of onset into less than or more than 4.5 hours onset, using CT scan and National Institute of Health Stroke Scale(NIHSS). Methods: Acute stroke patients with NIHSS ≥8 and CT within 24 hours of onset were included. The control group included 100 normal CT. Two reviewers blinded to clinical information independently reviewed all images. CT was graded as 0-normal, grade-I poorly-demarcated hypodensity and grade-II well-demarcated hypodensity. Hounsfield unit (HU) calculated in the area of interest using 0.5-1 cm area and compared with the contralateral side (n=44). The diagnosis was confirmed from follow-up scans. Results: A total 120 CT-scans were reviewed. There were 65% males, age ranged from 39-90 years. < 4.5 hour group : Sixty-nine CT were graded as <4.5-hours, 87%(n=60) were correctly graded (p<0.0001) and 13%(n=9), false negative) were incorrectly assigned to > 4.5 hours category. Both observers were incorrect on same eight CT-scans. Five of the false negative (assigned to >4.5-hours) were in 2.30-3.0 hours range with average NIHSS of 13. Four patients under two hours developed hypodensity, assigned to >4.5 hour category with average NIHSS of 21. Average NIHSS of the group was 15. > 4.5 hours group: Fifty-one CT were over 4.5 hours. Forty-four (86%) were correctly graded as >4.5-hours (p<0.0001) and seven (14%) patients were incorrectly assigned to <4.5 hour category (false positive). Six false positive patients were in 3.30-4.10 time range, average NIHSS of 15. Average NIHSS of >4.5-hour group was 14. Eleven incorrectly categorized scans [false negative (n=5) and positive (n=6)] tend to fall in the 2.45-4.10 hours range. Twenty-five (21%) CT scans were normal, all under three hours except one with NIHSS ≥8 at seven hours. HU were measured in 44 patients. Average HU of patients in <4.5 hour category (n=20) was 3.5 and >4.5 hour category (n=24) was 7.5. Conclusion: Acute stroke with unknown time of onset, NIHSS >8 and CT scan changes of grade 0-I indicate <4.5 hours stroke onset. Higher NIHSS patients can develop early hypodensity, incorrectly suggesting >4.5 hours onset (false negative).

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Early CT Changes Do Not Predict Parenchymal Haemorrhage Following Streptokinase Therapy In Acute Stroke.

Stroke ◽

10.1161/str.32.suppl_1.370-d ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 370-371

Author(s):

Amanda K Gilligan ◽

Romesh Markus ◽

Stephen J Read ◽

Velandai Srikanth ◽

Gregory Fitt ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Acute Stroke ◽

Ct Scans ◽

Increased Risk ◽

Haemorrhagic Infarction ◽

The Usa ◽

Streptokinase Therapy ◽

Acute Changes ◽

Stroke Death

P173 Aims Recent thrombolytic trials in acute stroke, and acute treatment in the USA, exclude patients with early CT changes of infarction affecting greater than one third of the middle cerebral artery (MCA) territory because of a possible increased risk of parenchymal haemorrhage. We reviewed CT scans of patients recruited into the Australian Streptokinase Trial to determine whether such changes or other factors were predictive in this group of patients. Methodology Acute CT scans were classified by three neurology research fellows according to ECASS criteria in 264 patients. Where consensus was not reached, a panel of ECASS trained physicians reviewed the scans. Haemorrhage on second CT were classified into haemorrhagic infarction or parenchymal haemorrhage. Results CT s showed no acute changes in 36%, minor ischaemic changes (<1/3 MCA territory) in 29%, and major ischaemic changes (>1/3 MCA territory) in 35%. Major early ischaemic changes were predictive of haemorrhagic infarction (p=0.037) and stroke death (p= <0.001). Major changes were not predictive of parenchymal haemorrhage (O.R.=0.70 95% C.I.= 0.30 - 1.66). Parenchymal haemorrhage was not more likely with any early CT changes or delays in time to therapy but was predictive of death and severe disability. Systolic blood pressure prior to treatment was significantly higher in patient s with secondary parenchymal haemorrhage(p = 0.03). Discussion Early CT changes were predictive of poor outcome but not predictive of parenchymal haemorrhage. The risk of parenchymal haemorrage was increased with moderately increased systolic blood pressure. Excluding patients with high risk of parenchymal haemorrhage, may improve the safety and overall efficacy of thrombolytic therapy. The findings of this study do not support the exclusion of patients on CT criteria.

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Acute stroke units and early CT scans are linked to lower in-hospital mortality rates

BMJ ◽

10.1136/bmj.328.7436.369 ◽

2004 ◽

Vol 328 (7436) ◽

pp. 369 ◽

Cited By ~ 3

Keyword(s):

Hospital Mortality ◽

Acute Stroke ◽

Mortality Rates ◽

Ct Scans ◽

Stroke Units

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57 The Workload Distribution and Response Times of FAST Scans in a Level 3 Hospital in Ireland

Age and Ageing ◽

10.1093/ageing/afz103.33 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Caoimhe McGarvey ◽

Paul O'Brien

Keyword(s):

Acute Stroke ◽

Response Times ◽

Time Windows ◽

Standard Of Care ◽

Work Load ◽

Ct Scans ◽

Ageing Population ◽

Out Of Hours ◽

Level 3 ◽

Workload Distribution

Abstract Background With the advent of time sensitive treatments like thrombolysis and thrombectomy for acute ischaemic stroke, it would be expected that stroke CT would place an increased demand on CT services out of hours. Our aim is to demonstrate the change in the workload distribution in the investigation and management of acute stroke over the last year. Methods Data was collected from the radiology systems used in our hospital (NIMIS/PACS). Firstly, CT multiphase angiograms done between 17/10/2017 and 17/10/2018 were examined, followed by all FAST-positive CT brains in the same period. Arrival times for FAST positive patients were collected from the ED Symphony system. These details were used to calculate time to CT and time to report in hours and minutes. Scans were categorised into 5-time windows, in and out of hours. The process was repeated for CT brain and all other CT scans for comparison. Results 58.14% of all FAST-positive CT scans were performed out of hours. FAST positive scans accounted for 9.49% of all out of hour CT scans, this rose to 20% when examining the out of hour scans from Monday to Friday. The most common indication for non-FAST positive CT was trauma. There was a higher likelihood of receiving a CTA during hours as opposed to out of hours, (73.33% vs 66.94%). Median time to CT in FAST positive patients: window 1 – 30mins, window 2 – 49mins, window 3 – 49mins, window 4 – 34mins, window 5 – 39mins. Conclusion Stroke CT will continue to increase the out of hours work load for CT departments across the country especially with our ageing population. It is vital that services, particularly in level 3 stroke centres, are adequately equipped in terms of staffing to meet the highest standard of care in the management of acute stroke.

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The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽

10.1024/1012-5302.12.1.21 ◽

1999 ◽

Vol 12 (1) ◽

pp. 21-27

Author(s):

Marit Kirkevold

Keyword(s):

Acute Stroke ◽

Theoretical Perspective ◽

Stroke Patients ◽

Role Of Nursing ◽

Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

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