22. European Stroke Conference 2013 Acute stroke: clinical patterns and practise including nursing Reliability of body weight estimates to determine accuracy of thrombolytic dosing in acute ischaemic stroke. E.J. Catangui1, D. Ames2, O. Geraghty3, J. Slark4 Imperial College Healthcare NHS Trust, London, UNITED KINGDOM1, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM2, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM3, Imperial College Healthcare NHS Trust, London, UNITED KING-DOM4 Background:Imperial College Healthcare NHS Trust (ICHT) offers a 24/7 thrombolysis service. The stroke team, including nurses, attend every thrombolysis call and assess stroke patients for eligibility to receive clot busting treatment. Before treatment, the team approximates the patient’s weight using visual body estimation. It is useful if a patient is dysphasic or no family are present to provide infor-mation about the patient’s body weight. Method:Prospective data was collected from August 2012 to December 2012 to evaluate (a) estimated patient’s weight prior to treatment (b) actual patient weight after 24 hours (c) calculated dosage of alteplase (d) post thrombolysis complications, (e) NIHSS score at 72 hours or upon discharge. Results:47 patients were thrombolysed during the audit period. Of the 47 thrombolysed patients, 26 had their weight overestimated by an average of 5kg. Based on recommended alteplase dosage, there were 26 errors in total ranging from 0mg- 5mg in 19 patients, 6mg-10 mg in 5 patients and above 11mg in 2 patients.15 had their weight underestimated by an average of 6.2 kg .Of these, under doses ranged from 0mg- 5mg for 8patients, 6mg-10 mg for 5 and above 11mg for 2 patients. Using NIHSS, 16 patients had NIHSS of 0 after 72 hours. Of these16 patients, 7 received a “lower dose” of 7mg and 6 had a higher dose of 4.8mg and 3 received the rec-ommended dosage. 5 patients whose alteplase dose was over 4.6 mg had an NIHSS of 5 to 15 and did not show any improvement in their functional outcomes. All complications occurred in those who received a higher dose (above 5mg), 3 asymptomatic intracranial haemorrhage, 1 bruising and 1 angioedema. Conclusion:The use of visual body estimation can either under or over estimate pa-tient’s weight which inevitably leads to dosing errors. Our data show that patients receiving a lower dose and or the right dose of alteplase had favourable outcomes. However, thrombolysis complica-tions and adverse drug reactions were seen in patients who received a higher dose of the treatment. ICHT is currently reviewing ways to ensure patients are accurately weighed at the front door to avoid any potential errors. 202 © 2013 S. Karger AG, Basel 7. Nurses & AHP‘s Meeting 2014 Acute stroke: clinical patterns and practise including nursing Consent for brain tissue donation after intracerebral haemorrhage: a community-based study C. Lerpiniere1, N. Samarasekera2, A. Fonville3, T. Millar4, A. Torgeson5, J. Ironside6, C. Smith7, R. Al-Shahi Salman8 Edinburgh University, Edinburgh, UNITED KINGDOM1, Department of Clinical Neoroscienc-es Lothian University Hospital Trust, Edinburgh, UNITED KINGDOM2, Academic Medical Centre University of Amsterdam, Amsterdam, THE NETHERLANDS3, Edunburgh University, Edinburgh, UNITED KINGDOM4, Department of Pathology Lothian University Hospital Trust, Edinburgh, UNITED KINGDOM5, Edinburgh University, Edinburgh, UNITED KINGDOM6, Department of Pathology Lothian University Hospital Trust, Edinburgh, UNITED KINGDOM7, Edinburgh Uni-versity, Edinburgh, UNITED KINGDOM8 Background Obtaining post mortem brain tissue following a spontaneous intracerebral haemorrhage (ICH) may help to elucidate ICH cause. We started an ICH brain tissue donation programme in 2010 as part of on-going research into ICH. In this paper we evaluate whether the characteristics of those who gave consent differed from those who did not. Methods We used multiple overlapping sources of case ascertainment to identify every adult diagnosed from 1st June 2010-31st May 2011 with ICH in the Lothian region of Scotland. We sought consent from patients with ICH (or their nearest relative if the patient lacked mental capacity) to obtain brain tis-sue samples after death. Results Of 141 adults with ICH, 45 (32%) could not be approached to consider donation, of whom 24 (53%) had died before being ascertained. Of 96 adults approached, 47 (49%, 95% confidence interval CI 39-59%) consented to donate brain tissue when they died. There were no differences between those who did versus those who did not consent in male sex (26 55% vs 19 39%, p=0.10), age (mean age 73 years ± standard deviation SD 13 vs 73 ± 14; p=0.96), Glasgow Coma Scale score on ad-mission (median score 13, inter-quartile range IQR 10-15 vs 14, IQR 12-15; p=0.07) and other markers of ICH severity (ICH volume and intraventricular extension).The most frequent reason to consent was the potential benefit to others. The most frequent reason for declining was that the per-son asked felt unable to make the decision. Those who died and became donors (n=24) were similar in their demographic characteristics but had larger ICHs than the rest of the cohort (median volume 36ml IQR 22-85 vs 17ml IQR 5-48; p=0.002). Conclusions Patients and their families are willing to consider post mortem brain tissue donation following ICH. The characteristics of patients consenting to brain donation after ICH seem comparable to those in an entire community, although those who donate have larger ICH volumes.
Karger_ESC London_2013
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