London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 647 572 Acute stroke: emergency management, stroke units and complications Missed opportunities for thrombolysis in young adults with ischemic stroke S. Chaturvedi1, K. Rajamani2, P. Bhattacharya3 Wayne State University, Detroit, USA1, Wayne State University, Detroit, USA2, Wayne State Uni-versity, Detroit, USA3 Background: Recent studies have suggested an increasing frequency of stroke in young adults. Previous analysis of the SITS-ISTR registry found that stroke patients between 18-50 years derive greater benefit from thrombolysis compared to older patients (Neurol 2012; 78: 880-87). We sought to analyze how frequently young stroke patients present within three hours, how often tissue plas-minogen activator (tPA) is administered, and the reasons for lack of use of thrombolysis. Methods: A prospectively maintained Young Stroke Registry was reviewed. Information on demo-graphic variables, presentation within three hours, initial Emergency Department (ED) diagnosis, and use of acute stroke therapies was recorded. Results: 81 patients (59% women) with a mean age of 37.7 years were evaluated. Overall, 23/81 (28%) patients presented within three hours of symptom onset. Ten of 23 received thrombolytic therapy (8 intravenous, 2 intra-arterial). In the remaining 13 patients, six were misdiagnosed and discharged from the ED. Other reasons for not administering tPA were mild or improving symptoms (two patients), postpartum state (1), possible venous sinus thrombosis (1), seizure at symptom onset (1), possible subarachnoid hemorrhage (1), and discomfort with tPA use. Three of the patients who were misdiagnosed had long term disability. Conclusions: Slightly more than half of young stroke patients presenting to the ED within three hours do not receive thrombolysis. Misdiagnosis of stroke (46%) was the most common reason for not administering tPA in patients who presented within three hours. Further ED involvement by neu-rologists or acute stroke teams could reduce the misdiagnosis rate in young adults with stroke-like symptoms and potentially reduce the rate of long-term disability in this group of patients. 573 Acute stroke: emergency management, stroke units and complications Thrombolysis in Canada: Results of the Canadian Stroke Audit M.D. HILL1, P. Lindsay2, J. Fang3, M.K. Kapral4, R. Cote5 Canadian Stroke Audit Investigaators University of Calgary, Calgary, CANADA1, University of Toronto, Toronto, CANADA2, Univer-sity of Toronto, Toronto, CANADA3, University of Toronto, Toronto, CANADA4, McGill Universi-ty, Montreal, CANADA5 Background Stroke care in Canada is varies widely in quality and extent. The use of thrombolysis for acute isch-emic stroke is an important quality indicator. We conducted a national stroke audit in every prov-ince in Canada by randomly sampling 10,000 charts to assess the quality of stroke care. We evaluat-ed the use of thrombolysis for stroke in Canada. Methods We used administrative data sources to draw a weighted random sample of stroke cases from one year for detailed chart review. Sampling was over-weighted for smaller provinces and under-repre-sented populations. Hospitals with less than 20 stroke admissions per year were excluded. Charts were audited by on-site review by trained abstractors. Data were pooled anonymously and are re-ported using standard descriptive statistics. We report the proportion of thrombolysis use, complica-tions, and outcomes stratified by hospital centre type. Results The sampling frame consisted of 38046 strokes reported using administrative data codes (ICD10 – I60, I61, I63, I64, G45, H34.1, I67.6) in fiscal 2010. Data from Ontario are not yet merged with the full data set such that these data represent data from 9 provinces. 6143 ischemic strokes were reviewed of which 455 (7.4% CI95 6.7-8.1) received thrombolysis. At comprehensive stroke cen-tres, 11.9% (CI95 10.6-13.3) (294/2469) received thrombolysis compared to 4.4% at intermediate or primary stroke centres. The top three reasons for not giving thrombolysis were similar in both com-prehensive vs. intermediate/primary stroke centres: arrival beyond 4.5h (56%/43%), no documented reason (21%/33%), stroke too mild (19/14%). Overall 30-d case mortality among thrombolysed pa-tients was 14%. Conclusions Rates of thrombolysis use are higher in comprehensive stroke centres. Overall treatment rates re-main modest. There is a persisting evidence to practice gap and therefore continued room for edu-cation and improvement.
Karger_ESC London_2013
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