scholarly journals Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window

2021 ◽  
Vol 12 ◽  
Author(s):  
Erik Simon ◽  
Matin Forghani ◽  
Andrij Abramyuk ◽  
Simon Winzer ◽  
Claudia Wojciechowski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Hospital Discharge ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Short Term ◽  
Discharge Disposition ◽  
Favorable Functional Outcome

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.

Abstract WP19: Transfer Selection for Endovascular Therapy of Ischemic Stroke within A Collaborative Network: Off-site Versus On-site Neurology Service

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Simon M Winzer ◽  
Kristian Barlinn ◽  
Johannes Gerber ◽  
Timo Siepmann ◽  
Lars-Peder Pallesen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Comprehensive Stroke Center ◽  
Favorable Functional Outcome ◽  
Selection Of Patients ◽  
Selection Of

Introduction: Selection of patients for endovascular therapy (EVT) may depend on the hospital providing first line assessment. In our collaborative stroke network, we aimed to compare clinical characteristics and outcomes in ischemic stroke patients undergoing EVT who were transferred from telestroke hospitals following teleconsultation and in those transferred from hospitals providing on-site neurology service. Methods: We analyzed prospectively collected data from consecutive ischemic stroke patients who underwent emergent EVT at our comprehensive stroke center (01/2010 to 12/2014) after acute transfer from either telestroke hospitals or non-telestroke hospitals with on-site neurology service. We compared baseline characteristics, onset-to-EVT time, symptomatic intracranial hemorrhage (sICH), favorable functional outcome (mRS 0-2) at discharge and in-hospital mortality. Results: Among 133 transferred patients who underwent emergent EVT: median age 67 years (IQR, 15); 56% men; median NIHSS score 17 (21); 52% had anterior and 48% posterior circulation stroke. Sixty-five patients (49%) were transferred from telestroke and 68 (51%) from non-telestroke hospitals. Telestroke patients were less severely affected (median NIHSS scores: 15 [7] vs. 22 [20]; p=.0005) and more likely to have anterior circulation stroke (69% vs. 35%; p<.0001) compared with non-telestroke patients. No between-group differences were present with regard to demographics, vascular risk factors, intravenous tPA rate and onset-to-EVT time. In-hospital mortality was lower among telestroke compared with non-telestroke patients (11% vs. 26%; p=.026). There were no differences in sICH (5% vs. 4%; p=1.0) and favorable functional outcome (17% vs. 18%; p=1.0). Conclusions: Patients transferred from telestroke hospitals were twice as often treated for anterior circulation stroke than those from non-telestroke neurological hospitals within our stroke network. This might be explained by more conservative selection of patients potentially amenable for EVT in hospitals harboring on-site neurology service but no EVT-capability. As our data was acquired prior to evidence from the positive EVT trials, further research is warranted to elaborate these findings.

Abstract TP16: Short-Term Thrombectomy Outcomes Beyond the Traditional 6-Hour Time Window: Analysis of a Multi-Hub Telestroke Network

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Archit Bhatt ◽  
Lindsay Lucas ◽  
Elizabeth Baraban
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracranial Hemorrhage ◽  
Time Window ◽  
Stroke Patients ◽  
Short Term ◽  
Real World Data ◽  
Term Outcome ◽  
Discharge Disposition ◽  
Significant Difference

Background/Purpose: Acute ischemic stroke patients with large vessel occlusions are traditionally treated with thrombectomy within a 6-hour time window. Often patients get groin punctures for thrombectomy beyond 6 hours. The purpose of our study is to report real world data comparing short-term outcome differences in patients who receive groin punctures within 6 hours versus beyond 6 hours in a multi-hub telestroke network. Method: Data obtained from the Providence Health and Services Get With the Guidelines stroke registry were used to identify AIS patients who received intra-arterial (IA) intervention and were discharged from the hospital between November 2014 and May 2016. Patients were categorized as having Last Known Well-to-Groin-Puncture times (LKW-to-GP) over six hours or LKW-to-GP below or equal to six hours. Outcomes were modified rankin score (mRS) at discharge (slight or no disability versus moderate disability to dead), discharge disposition (home versus not home), change in NIHSS from admittance to discharge, and length of stay (LOS). Multivariate analyses were used to determine impact of the LKW-to-GP group on outcomes adjusting for post thrombolysis in cerebral infarction (TICI) grade, pre-symptom onset mRS, and admission NIHSS score. Intracranial hemorrhage rates were compared between the two groups using Fisher’s exact test. Results: We identified 136 ischemic stroke patients, 46.3% female with a mean age of 70.7 years (±14.6), who received IA intervention and were discharged between November 2014 and May 2016. Of those, 21% (n=29) had LKW-to-GP below or equal to six hours and 79% (n=107) had LKW-to-GP above six hours. After adjusting for covariates, there were no statistically significant differences in discharge mRS (p=.284), discharge disposition (p=.736), length of stay (p=.473) and change in NIHSS (p=.135). Unadjusted intracranial hemorrhage rates (p=.101) between the two LKW-to-GP groups were also not significant. Conclusions: We discovered one in five patients were treated beyond the traditional time window in a multi-hub telestroke network. We found no statistically significant difference in short term outcomes in patients receiving thrombectomy beyond 6 hours compared to those receiving thrombectomy within 6 hours.

Abstract W P379: Pre-treatment with Selective Serotonin Reuptake Inhibitors is Associated with Improved Short-term Outcome in Acute Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Timo Siepmann ◽  
Jessica Kepplinger ◽  
Charlotte Zerna ◽  
Ana Isabel Penzlin ◽  
Heinz Reichmann ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Stroke Patients ◽  
Short Term ◽  
Post Stroke ◽  
Pre Treatment ◽  
Favorable Functional Outcome

Background and Purpose: Treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) following acute ischemic stroke was shown to improve functional and motor recovery independently of depression, possibly mediated by long-term mechanisms such as increased brain plasticity. In animal studies, chronic SSRI treatment is superior over short-term SSRI in evoking neurogenesis but the applicability of this observation to humans remains unelucidated. We hypothesized that pre-treatment with SSRI in acute ischemic stroke patients is associated with improved recovery compared to post-stroke SSRI. Subjects and Methods: We performed an exploratory analysis in consecutive acute ischemic stroke patients who were pre-treated or treated de novo either with fluoxetine, citalopram or escitalopram. Effects of SSRI-pre-treatment on short-term clinical (total NIHSS and NIHSS motor items) and functional (mRS) outcome at discharge compared to post-stroke SSRI were assessed using bivariate and multivariate analyses. Results: Of 2653 patients screened, 239 were included (aged 69±14 years, mean±SD; 42% men, baseline median NIHSS 7 [IQR, 10]). Compared to post-stroke SSRI (n=188), in the SSRI pre-treatment group (n=51) favorable functional outcome at discharge (mRS≤2) was more frequent (41% vs. 20%; p=0.002), duration of hospitalization was shorter (median: 7 versus 11 days; p<0.0001), and there was a non-significant trend toward improved motor recovery (decrease in NIHSS motor items ≥2 points or 0-1 at discharge; 63% vs. 49%; p=0.08). However there was no such difference in total NIHSS recovery (≥4 points or 0-1 at discharge; p=n.s.). Pre-treatment with SSRI was an independent predictor of favorable functional outcome (mRS≤2) at discharge (OR: 4.00; 95%CI: 1.68-9.57; p=0.002) after adjusting for age, pre-stroke mRS, baseline NIHSS and IV-thrombolysis. Conclusions: Our data suggest that pre-treatment with SSRI may be linked to early clinical recovery after acute ischemic stroke and support the hypothesis that pre-stroke SSRI might be superior to post-stroke SSRI.

Abstract WMP112: Safety and Efficacy of Intravenous Thrombolysis and Endovascular Therapy in Children with Acute Ischemic Stroke: A Systematic Review and Meta-analysis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Juliana Pacheco ◽  
Simon Winzer ◽  
Jessica Barlinn ◽  
Heinz Reichmann ◽  
Volker Puetz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Pediatric Stroke ◽  
Stroke Patients ◽  
Safety And Efficacy

Background: Although intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) and endovascular therapy (EVT) are considered standard-of-care treatment of acute ischemic stroke in adults, safety and efficacy of these treatment modalities in children is unknown to date. We reviewed current literature and synthesized data on safety and efficacy of IVT and EVT in children with ischemic stroke. Methods: We performed a systematic review and meta-analysis of all available case series and observational studies that evaluated safety of IVT and EVT in pediatric stroke patients aged less than 18 years. We searched the electronic databases Medline, PubMed, Cochrane Library, Google Scholar for eligible studies. Safety outcomes comprised any intracerebral hemorrhage post-treatment and in-hospital mortality. A random-effects model was used to compute pooled effect estimates and the I 2 statistic was used to assess heterogeneity. Our analysis complied with PRISMA statement. Results: We identified 152 records through database searching, of which only 3 studies with a total of 16,335 pediatric patients with ischemic stroke met our eligibility criteria. Of these studies, two explored safety of sole IVT and one combinatory IVT/EVT. In-hospital mortality rates were similar between pediatric stroke patients treated with either IVT or IVT/EVT and controls (odds ratio=0.85, 95%CI: 0.15-4.87; p=0.857), with moderate evidence of heterogeneity ( I 2 =64%). Risk of intracerebral hemorrhage was substantially increased in children receiving IVT (odds ratio=3.60, 95%CI: 1.66-7.80; p=0.001) compared with controls, with no evidence of heterogeneity ( I 2 =0%). Efficacy of revascularization therapies could not be analyzed due to lack of uniform outcome data in the included studies. Conclusions: Our synthesized data analysis revealed a substantial lack of evidence for acute revascularization treatment of children with ischemic stroke. While an increased risk of intracerebral hemorrhage related to IVT emerged in our analysis, further research is needed to elaborate these findings.

Abstract WP292: Discharge Disposition After Intracerebral Hemorrhage and Functional Outcomes

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jennifer Osborne ◽  
Padmini Sekar ◽  
Charles J Moomaw ◽  
David Y Hwang ◽  
Kevin N Sheth ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Hospital Discharge ◽  
Univariate Analysis ◽  
Outcome Variable ◽  
Medical Facility ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Medical Facilities ◽  
Ich Score

Introduction: Data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study previously reported racial/ethnic differences in discharge disposition after ICH hospitalization to home-like environments vs. medical facilities. We sought to explore how discharge disposition affects functional outcome for ICH patients with disability at time of hospital discharge. Methods: ERICH is a multi-center, prospective case-control study of ICH among whites, blacks, and Hispanics. Patients included in this analysis had pre-stroke modified Rankin Scale (mRS) < 3, available ICH volume measurements (log transformed), and mRS of 2-5 at discharge. The mRS at 3 months post onset was the primary outcome variable. Logistic regression was used to model the probability of 3-month functional disability (mRS≥3) against discharge disposition, adjusting for ICH score and dementia. Results: Between 08/2010 and 3/2015, 2964 ICH cases were enrolled, of whom 1627 qualified for analysis. Univariate analysis examined demographics, past medical history, social status (education level, marital status, employment), and type of insurance. In multivariate analysis, higher age, lower GCS, higher discharge mRS, non-lobar ICH location, higher ICH volume, presence of IVH, and history of dementia were independently associated with increased risk of mRS≥3 at 3 months. In a multivariate model that controlled for ICH score, patients who were mRS=3 at hospital discharge were more likely to be mRS ≥ 3 at 3 months if discharged to a medical facility rather than to home (p=.0153, OR 2.7, CI 1.2-6.2); additional independent predictors of 3-month mRS≥3 were presence of IVH (p=.002, OR 3.5, CI 1.8-6.6) and dementia (p=.04, OR 3.8, CI 1.1-13.7). However, patients who were mRS=4 at discharge were equally as likely to be mRS≥3 at 3 months, whether discharged home or to a medical facility (p=0.599, OR 0.9, CI 0.5-1.5). Conclusion: ICH patients with moderate disability at hospital discharge were more likely to have a favorable functional outcome at 3 months if discharged to a home environment vs. a medical facility. Future analysis is needed to look at the rate of complications for ICH patients at medical facilities vs. home-like environments that may affect 3-month outcome.

Influence of Statin Pretreatment on Initial Neurological Severity and Short-Term Functional Outcome in Acute Ischemic Stroke Patients: The Fukuoka Stroke Registry

2016 ◽  
Vol 42 (5-6) ◽  
pp. 395-403 ◽  
Author(s):  
Hiromi Ishikawa ◽  
Yoshinobu Wakisaka ◽  
Ryu Matsuo ◽  
Noriko Makihara ◽  
Jun Hata ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Scale Score ◽  
Multivariable Analysis ◽  
Statin Treatment ◽  
Neurological Symptoms ◽  
Stroke Patients ◽  
Short Term ◽  
Stroke Registry ◽  
Favorable Functional Outcome

Background: Statins have neuroprotective effects against ischemic stroke. However, associations between pre-stroke statin treatment and initial stroke severity and between the treatment and functional outcome remain controversial. This study aimed at determining these associations in ischemic stroke patients. Methods: Among patients registered in the Fukuoka Stroke Registry from June 2007 to October 2014, 3,848 patients with ischemic stroke within 24 h of onset, who had been functionally independent before onset, were enrolled in this study. Ischemic stroke was classified as cardioembolic or non-cardioembolic infarction. Primary and secondary study outcomes were mild neurological symptoms defined as a National Institutes of Health Stroke Scale score of ≤4 on admission and favorable functional outcome defined as a modified Rankin Scale score of ≤2 at discharge, respectively. Multivariable logistic regression models were used to quantify associations between pre-stroke statin treatment and study outcomes. Results: Of all 3,848 participants, 697 (18.1%) were taking statins prior to the stroke. The frequency of mild neurological symptoms was significantly higher in patients with pre-stroke statin treatment (64.1%) than in those without the treatment (58.3%, p < 0.01). Multivariable analysis showed that pre-stroke statin treatment was significantly associated with mild neurological symptoms (OR 1.31; 95% CI 1.04-1.65; p < 0.01). Sensitivity analysis in patients with dyslipidemia (n = 1,998) also showed the same trend between pre-stroke statin treatment and mild neurological symptoms (multivariable-adjusted OR 1.26; 95% CI 0.99-1.62; p = 0.06). In contrast, the frequency of favorable functional outcome was not different between patients with (67.0%) and without (65.3%) the treatment (p = 0.40). Multivariable analysis also showed no significant association between pre-stroke statin treatment and favorable functional outcome (OR 1.21; 95% CI 0.91-1.60; p = 0.19). Continuation of statin treatment, however, was significantly associated with favorable functional outcome among patients with pre-stroke statin treatment (multivariable-adjusted OR 2.17; 95% CI 1.16-4.00; p = 0.02). Conclusions: Pre-stroke statin treatment in ischemic stroke patients was significantly associated with mild neurological symptoms within 24 h of onset. Pre-stroke statin treatment per se did not significantly influence the short-term functional outcome; however, continuation of statin treatment during the acute stage of stroke seems to relate with favorable functional outcome for patients with pre-stroke statin treatment.

National trends in endovascular therapy for acute ischemic stroke: utilization and outcomes

2019 ◽  
Vol 12 (4) ◽  
pp. 356-362 ◽  
Author(s):  
Laura Stein ◽  
Stanley Tuhrim ◽  
Johanna Fifi ◽  
J Mocco ◽  
Mandip Dhamoon
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Intravenous Thrombolysis ◽  
Index Admission ◽  
Teaching Hospitals ◽  
Vessel Occlusion ◽  
Discharge Disposition ◽  
National Trends

ObjectiveFollowing widespread acceptance of endovascular therapy (ET) for large vessel occlusion stroke in 2015, we assessed nationwide utilization of revascularization for acute ischemic stroke (AIS).MethodsWe utilized the 2013–2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database. We identified AIS admissions, treatment with intravenous thrombolysis (IVT), ET, and vascular risk factors using International Classification of Disease Clinical Modification codes. Main predictor of outcome was the time period of index admission (‘pre-endovascular era (pre-EA)’ January 2013–January 2015 and ‘endovascular era (EA)’ February 2015– December 2016). We calculated the proportion of AIS admissions in which, first, VT and second, ET was performed. Among patients treated with ET, we examined the association between era and discharge disposition, in-hospital mortality during index admission, and 30-day readmission.ResultsThere were 925 363 index AIS admissions before the EA and 857 347 during. A higher proportion of AIS patients received IVT (8.4% vs 7.8%) and ET (2.6% vs 1.3%) in the EA. Although length of stay (LOS) was shorter in the EA (5.70 vs 6.80 days), total charges were greater ($56 691 vs $53 878), and admissions were more often to a metropolitan hospital (65.2% vs 57.2%). Among those treated with ET, a smaller proportion received IVT (29.7% vs 44.9%), LOS was substantively shorter (9.75 vs 12.76 days), and patients had a lower odds of discharge home.ConclusionsThe utilization of ET has doubled in the EA but ET remains underutilized. ET is predominantly provided at metropolitan teaching hospitals and associated with higher charges despite shorter LOS and unchanged in-hospital mortality.

Female Stroke

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 406-415
Author(s):  
Anna K. Bonkhoff ◽  
André Karch ◽  
Ralph Weber ◽  
Jürgen Wellmann ◽  
Klaus Berger
Keyword(s):  
Sex Differences ◽  
Hospital Mortality ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Time Interval ◽  
Stroke Severity ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Female Patients ◽  
Favorable Functional Outcome

Background and Purpose: Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry. Methods: Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3 steps: (1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018. Results: Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000–2009: OR, 0.99 [95% CI, 0.94–1.03]; 2010–2018: OR, 1.0 [0.98–1.02]), but women were more likely to receive intraarterial therapy (2010–2018: OR, 1.12 [1.08–1.15]). Despite higher disability on admission (2000–2009: OR, 1.10 [1.07–1.13]; 2010–2018: OR, 1.09 [1.07–1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003–2009: OR, 1.05 [1.02–1.09]; 2010–2018: OR, 1.05 [1.04–1.07]) and experienced lower in-hospital mortality (2000–2009: OR, 0.92 [0.86–0.97]; 2010–2018: OR, 0.91 [0.88–0.93]). Conclusions: Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

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