London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 641 561 Acute stroke: emergency management, stroke units and complications The association between time to stroke unit admission and receipt of multidisciplinary stroke care J.T. Campbell1, L Paley2, M Roughton3, B Bray4, S Kavanagh5, M James6, G Cloud7, P Tyrrell8, A.G. Rudd9 Royal College of Physicians, London, UNITED KINGDOM1, Royal College of Physicians, Lon-don, UNITED KINGDOM2, Royal College of Physicians, London, UNITED KINGDOM3, King’s College London, London, UNITED KINGDOM4, Royal College of Physicians, London, UNITED KINGDOM5, Royal Devon and Exeter NHS Foundation Trust, Exeter, UNITED KINGDOM6, St George’s Healthcare NHS Trust, London, UNITED KINGDOM7, University of Manchester, Man-chester, UNITED KINGDOM8, Guy’s and St Thomas’ NHS Foundation Trust, London, UNITED KINGDOM9 Background: There is a large body of evidence demonstrating the effectiveness of stroke unit care. Intercollegiate Stroke Working Party guidelines in the United Kingdom recommend admission to stroke unit within 4 hours of hospital admission. We aimed to identify if delays in stroke unit admis-sion beyond 4 hours were associated with the probability of receiving comprehensive multidisci-plinary specialist stroke care. Methods: Data were extracted from the Stroke Improvement National Audit Programme (SINAP) of adults with acute stroke admitted to a participating hospital in England from January 2011-Septem-ber 2012. Compliance with stroke specific care bundles in the first 72 hours of admission was com-pared for patients admitted to a stroke unit within 4 hours, 4-24 hours and 24-72 hours. Results: Of 54 531 adults admitted with acute stroke to 110 hospitals, 36 112 (66%) were admit-ted to a stroke unit within 4 hours, 14 233 (26%) between 4 and 24 hours and 4186 (8%) between 24 and 72 hours after hospital admission. Patients admitted within four hours were more likely to receive a care bundle comprising nursing and therapist assessments within 24 hours and 72 hours (65%) compared to those admitted 4-24 hours (56%) or those admitted 24-72 hours (24%), Chi2 p<0.0001. A similar association was observed for patients receiving a care bundle comprising nu-trition screening and formal swallow assessments within 72 hours (92%, 87%, 77% respectively), Chi2 p<0.0001. Conclusions: Patients experiencing delays in stroke unit admission longer than 4 hours of arrival in hospital are less likely to receive specialist multidisciplinary stroke care in the first 3 days of admis-sion. Ensuring that more patients are admitted quickly to stroke units may increase the proportion receiving specialist multidisciplinary stroke care. 562 Acute stroke: emergency management, stroke units and complications Estimated weight of patients in emergency: Reliable for thrombolysis? S. Deltour1, Y. L’Hermitte2, G. Mutlu3, S. Crozier4, A. Leger5, C. Zavanone6, Y. Samson7 Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE1, SAMU 77/SMUR/Unit Care, Hôpital Marc Jacquet,, Melun, FRANCE2, Stroke Unit, HOSPITAL PITIE SALPETRIERE, PARIS, FRANCE3, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE4, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE5, Stroke Unit, HOSPITAL PITIE SALPETRI-ERE, Paris, FRANCE6, Stroke Unit, HOSPITAL PITIE SALPETRIERE, Paris, FRANCE7, Stroke Unit, HOSPITAL PITIE SALPETRIERE8 Introduction: Before thrombolysis, knowledge of the patient’s weight is required (Tissue Plasminogen Activa-tor :0.9 mg / kg). Neurovascular units have equipment to weigh deficient patients, but emergency services remain largely unequipped (expensive and bulky hardware). Currently, tele-thrombolysis develops in the emergency services. Therefore, we investigated whether the estimated weight of the patients was sufficient. Method: For each patient with suspected stroke and potential “candidate” to thrombolysis, weight estima-tion was performed by averaging estimates made by five members (at least) of the healthcare team: Team EMS, firefighters, manipulators, radiologists , nurse-aides, nurses and neurologists (external, internal, senior). Different values were collected on a form. We then asked the patient to give us his weight. There is no answer, the reason was clear: “Unable to answer” or “do not know”. Finally, weighing the patient was performed and compared to the estimate. A subgroup analysis was able to identify the best “assessor”. Results: Between September 2011 and September 2012, we collected 60 evaluation forms (50% female, mean age 63 years, median weight 72Kg). Of patients able to respond (48 or 80%), 31 patients (52%) knew their weight. The error of the estimate (estimated weight difference compared to the actual weight of the patient) was on average 4.5 kg (equivalent to an error of 4.1 mg rTpa) with dif-ferences of up to 25 kg, obese patients or very thin are the most difficult to assess. The estimation of the nurse-aides appear more reliable with standard deviation nevertheless amounted to 8.9. Conclusion: These results are insufficient to conclude formally. However to weight “standard”, the evaluation is relatively reliable and especially if it is done by the nurse-aides.
Karger_ESC London_2013
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