Delay in presentation of acute ischemic stroke in Lahore General Hospital, Lahore

Objectives: To find out the time interval from onset of the symptoms to admission in the hospital of patients suffering from acute ischemic stroke, in order to assess the feasibility of thrombolytic therapy in Lahore General Hospital. Design: Hospital-based, prospective and observational study Setting: Lahore General Hospital Lahore. Duration: Six months from January - June 2004. Patients: Seventy two patients with acute ischemic stroke diagnosed on basis of clinical findings and CT scan. Methods: Patients o f a cute ischemic stroke including cerebral infarct, T IA, venous infarct and lacunar infarct were diagnosed on basis of clinical history, examination and CT scan and enrolled in the study. Data was collected on a Performa. Time taken by patients to reach hospital after onset of symptoms, distance of patients` residences from hospital, education level of patients and time required to do a CT scan after arrival of patient in hospital were studied. Results: 54.2% were male and mean age of patients was 60 years. 58 patients had cerebral infarction, TIA`s and venous infarction were 8 and 6 respectively. Delay in presentation was divided in three groups. Within three hours (hrs) 15 (21%) patients arrived. 54 and 18 patients arrived in 3-- 24 hrs group and >24 firs group. Mean distance was roughly 44 km. Mean distance for 0-3hrs, 3-24hrs and >24hrs group was 14, 35, and 85 Km respectively. Average time required to do CT scan was nine hours after arrival of patient in emergency department. Sixty-five percent of patients coming were illiterate. Conclusion: Majority of the patients with ischemic stroke present late to. emergency department. Many factors including distance from hospital, illiteracy, non-availability of ambulance services responsible for it. Evaluation-of patients and provision of urgent CT scan is required. in hospitals.

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Abstract W P5: “No Turn Back Approach” to Reduce Treatment Time for Endovascular Treatment of Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wp5 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Adnan I Qureshi ◽

Hossam Egila ◽

Malik M Adil ◽

Harris Siddiqi ◽

Nidaullah Mian ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Treatment Time ◽

National Institutes Of Health ◽

Time Interval ◽

Ct Scanner ◽

Stroke Patients ◽

Computed Tomographic

Background: A delay in endovascular treatment is less likely if acute ischemic stroke patients proceed from emergency department(ED) to computed tomographic (CT) scanner and directly to angiographic suite (no turn back approach). We determined the feasibility of the “no turn back approach” and its effect on treatment times and patient outcomes. Methods: The primary outcomes were procedures performed with a time interval: 1) between ED arrival and microcatheter placement of <120 minutes; and 2) between CT scan acquisition and microcatheter placement of <90 minutes. We determined the affect of the “no turn back approach” on favorable outcome at discharge. Results: There was a significantly higher rate of CT scan acquisition and microcatheter placement time of <90 minutes in patients in whom “no turn back approach” was used (57.6% versus 31.6%, p=0.0007). There was a significantly higher rate of ED arrival to microcatheter placement time of <120 minutes in patients in whom “no turn back approach” was used (31.8% versus 13.7%, p=0.004). In the exploratory analysis, there was a trend towards higher rate of favorable outcomes (OR 1.6, 95% CI 0.9-2.8, p=0.07) among those treated with “no turn back approach” after adjusting for age, admission National Institutes of Health Stroke Scale (NIHSS) score strata, congestive heart failure and diabetes mellitus. Conclusions: The “no turn back approach” appeared to be feasible and reduced the time interval between ED arrival and microcatheter placement in acute ischemic stroke patients undergoing endovascular treatment.

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Emergency medical dispatchers’ ability to identify large vessel occlusion stroke during emergency calls

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00914-1 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Pauli E. T. Vuorinen ◽

Jyrki P. J. Ollikainen ◽

Pasi A. Ketola ◽

Riikka-Liisa K. Vuorinen ◽

Piritta A. Setälä ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Emergency Call ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Emergency Response System ◽

Emergency Medical ◽

Cortical Ischemia

Abstract Background In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). We aimed to determine if an emergency dispatcher can recognise LVO stroke during an emergency call by asking the caller a binary question regarding whether the patient’s head or gaze is away from the side of the hemiparesis or not. Further, we investigated if the paramedics can confirm this sign at the scene. In the group of positive CED answers to the emergency dispatcher, we investigated what diagnoses these patients received at the emergency department (ED). Among all patients brought to ED and subsequently treated with mechanical thrombectomy (MT) we tracked the proportion of patients with a positive CED answer during the emergency call. Methods We collected data on all stroke dispatches in the city of Tampere, Finland, from 13 February 2019 to 31 October 2020. We then reviewed all patient records from cases where the dispatcher had marked ‘yes’ to the question regarding patient CED in the computer-aided emergency response system. We also viewed all emergency department admissions to see how many patients in total were treated with MT during the period studied. Results Out of 1913 dispatches, we found 81 cases (4%) in which the caller had verified CED during the emergency call. Twenty-four of these patients were diagnosed with acute ischemic stroke. Paramedics confirmed CED in only 9 (11%) of these 81 patients. Two patients with positive CED answers during the emergency call and 19 other patients brought to the emergency department were treated with MT. Conclusion A small minority of stroke dispatches include a positive answer to the CED question but paramedics rarely confirm the emergency medical dispatcher’s suspicion of CED as a sign of LVO. Few patients in need of MT can be found this way. Stroke dispatch protocol with a CED question needs intensive implementation.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Emergency Department Adherence to American Heart Association Guidelines for Blood Pressure Management in Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.111.637983 ◽

2012 ◽

Vol 43 (2) ◽

pp. 557-559 ◽

Cited By ~ 10

Author(s):

Erin McDonough Grise ◽

Opeolu Adeoye ◽

Christopher Lindsell ◽

Kathleen Alwell ◽

Charles Moomaw ◽

...

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Pressure Management ◽

Blood Pressure Management

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KORELASI KADAR LAJU ENDAP DARAH DENGAN NILAI ASPECTS PADA PASIEN STROKE ISKEMIK

Majalah Kedokteran Andalas ◽

10.22338/mka.v38.i1.p26-32.2015 ◽

2015 ◽

Vol 38 (1) ◽

pp. 26

Author(s):

Ratih Ismiranti Murni ◽

Dwi Pudjonarko ◽

Bambang Satoto ◽

Sukma Imawati

Keyword(s):

Diabetes Mellitus ◽

Ischemic Stroke ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Clinical Manifestations ◽

Stroke Patients ◽

Cross Sectional ◽

Emergency Imaging ◽

Brain Ct Scan ◽

Relationship Of

AbstrakStroke adalah penyebab utama ke-3 kematian di Amerika Serikat. Stroke iskemik adalah kondisi kompleks dengan etiologi dan manifestasi klinis bervariasi. CT Scan kepala adalah pencitraan darurat stroke membedakan dengan perdarahan intrakranial. Beberapa peneliti mengemukakan adanya korelasi independent dan hubungan pemeriksaan rutin biomarkers pada pasien stroke iskemik akut termasuk di dalamnya parameter inflamasi yang berperan pada patofisiologi iskemia otak. Tujuan penelitian ini mengetahui korelasi kadar LED dengan penilaian ASPECTS pada pasien stroke iskemik. Penelitian ini merupakan penelitian observasional analitik belah lintang dari catatan rekam medik. Selama periode Desember 2012 - Oktober 2014. Didapatkan 16 sampel yang memenuhi kriteria inklusi dan ekslusi. Dengan beberapa karakteristik subyek penelitian meliputi usia, jenis kelamin, hipertensi, diabetes mellitus, dislipidemia, kadar LED 1 dan 2, awitan stroke iskemik akut. Uji statistik Rank Spearman’s,dan uji bivariat maupun multivariat. Didapatkan hasil tidak ada korelasi antara nilai ASPECTS dengan kadar LED dan faktor yang mempengaruhi nilai ASPECTS.AbstractStroke is the third major cause of death in United States. Ischemic stroke results from complex conditions with various etiologies and clinical manifestations. Brain CT Scan is a stroke emergency imaging to differentiate intracranial hemorrhage. Several studies claimed there were independent correlation and relationship of biomarker in routine examination of acute ischemic stroke patients including inflammation parameters that contribute to the pathophysiology of brain ischemic. The purpose in this study was to identify correlation between ESR level and ASPECTS in ischemic stroke patients. The method of study was analytical observational cross sectional taken from medical record. It was performed in 16 patients that fulfill the inclusion and exclusion criteria during December 2012- October 2014. Several characteristics of subject that affecting ASPECTS included age, gender, hypertention, diabetes mellitus, dyslipidemia, ESR level 1 and 2, and onset of acute ischemic stroke were assessed. Analytical test was performed by Rank spearman’s test and multivariate test. There was no correlation between ASPECTS with ESR level and factors that affect ASPECTS.

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Evaluation of acute ischemic stroke using quantitative EEG: A comparison with conventional EEG and CT scan

Neurophysiologie Clinique ◽

10.1016/s0987-7053(98)80115-9 ◽

1998 ◽

Vol 28 (3) ◽

pp. 249-257 ◽

Cited By ~ 58

Author(s):

L Murri ◽

S Gori ◽

R Massetani ◽

E Bonanni ◽

F Marcella ◽

...

Keyword(s):

Ischemic Stroke ◽

Ct Scan ◽

Acute Ischemic Stroke ◽

Quantitative Eeg

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Abstract T P10: Hounsfield Unit Value and Clot Length in the Acutely Occlude Vessel and Time Required to Achieve Thrombectomy, Complications and Outcome

Stroke ◽

10.1161/str.45.suppl_1.tp10 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Alejandro Spiotta ◽

Jan Vargas ◽

Harris Hawk ◽

Raymond Turner ◽

Imran Chaudry ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Hounsfield Unit ◽

Hounsfield Units ◽

Unit Value ◽

Procedural Complications ◽

Noncontrast Ct ◽

Time Required

Introduction: Intra-arterial therapy for acute ischemic stroke (AIS) now has an established role. We investigated if Hounsfield Units (HU) quantification on noncontrast CT is associated with ease and efficacy of mechanical thrombectomy and outcomes. Methods: We retrospectively studied a prospectively maintained database of cases of acute ischemic stroke that underwent intra-arterial therapy between May 2008 and August 2012. Functional outcome was assessed by ninety-day follow up modified Rankin Scale (mRS). Patients were dichotomized base on time to recanalization. Hounsfield units were calculated on head CT. Thrombus location and length were determined on CT angiography. Simple linear regression was used to analyze the association between clot length, average HU, and other clinical variables. Results: 141 patients were included. There was no difference in clot length or average HU among patients with good recanalization achieved within an hour compared to those in which procedures extended beyond an hour. There was no relationship between clot length or density and recanalization. The thrombus length and density were not significantly different between patients with procedural complications and those without. The presence of post procedure intracranial hemorrhage was not associated with thrombus length or density. Ninety day mRS was not associated with thrombus length or density. Conclusions: We have not found any significant associations between either thrombus length or density and likelihood of recanalization, time to achieve recanalization, intraprocedural complications, postprocedural hemorrhage or functional outcome at ninety days. These results do not support a predictive value for thrombus quantification in the evaluation of AIS.

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Abstract WP280: Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

Stroke ◽

10.1161/str.44.suppl_1.awp280 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Gregg C Fonarow ◽

Eric E Smith ◽

Xin Zhao ◽

Eric D Peterson ◽

Ying Xian ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Stroke Care ◽

Ct Scanner ◽

Critical Pathways ◽

Intravenous Tissue Plasminogen Activator ◽

Tissue Plasminogen

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Methods: We surveyed 304 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle times in the 1/2008-2/2010 timeframe (prior to the initiation of Target: Stroke). The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter DTN times and further refined after pilot testing. Categorical responses are reported as frequencies. Results: Hospitals participating in the survey were 50% academic, median 163 (IQR 106-247) ischemic stroke admissions per year, median 10 (IQR 6-17) tPA treated patients per year, and had median 79 minute (IQR 71-89) DTN times. By survey, 214 of 304 hospitals (70%) reported initiating or revising strategies to reduce DTN times in the prior 2 years. Reported use of the different strategies varied in frequency, with use of ischemic stroke critical pathways, CT scanner located in the Emergency Department, and tPA being stored in the Emergency Department being the strategies least frequently employed (Table). As part of Target: Stroke participation, 279 of 304 hospitals (91.5%) indicated they planned to have a dedicated team focused on reducing DTN times. Conclusions: While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists. Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care.

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Abstract TP353: Use of Telestroke in a Metropolitan Stroke Code Process

Stroke ◽

10.1161/str.44.suppl_1.atp353 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Amy Castle ◽

Lana Stein ◽

Sandra Hanson ◽

Charles Ormiston ◽

Karen Porth

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Decision Tree ◽

Acute Ischemic Stroke ◽

Early Treatment ◽

Reperfusion Therapy ◽

Limited Knowledge ◽

Code Process ◽

Metropolitan Hospital ◽

Risk Of Treatment

BACKGROUND: Reperfusion therapy is the most important recent advance in early treatment for acute ischemic stroke, but remains underused and the timing of administration of treatment continues to be unacceptably delayed. The complexity of the decision tree and risk of treatment may be limiting use in the emergency department (ED) when those directing the therapy have limited knowledge and less comfort with administration of the drug. This review supports the hypothesis that utilizing telestroke to increase the Stroke Neurology expertise early in the stroke code in an organized stroke code process in a metropolitan hospital ED will improve the rate of use of reperfusion therapy and decrease the door-to-drug (DTD) times. METHODS and RESULTS: Telestroke was used to allow for Stroke Neurology presence and leadership in a redesigned stroke code process at 2 busy metropolitan hospitals beginning in 2009 at St. Joseph’s Hospital and 2010 at St. John’s Hospital. CONCLUSION: Telemedicine run stroke codes in a busy metropolitan ED resulted in increased use of reperfusion therapy and dramatic decreases in DTD times.

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