22. European Stroke Conference 601 Acute stroke: emergency management, stroke units and complications HYPERGLYCEMIA AND HEMORRHAGIC STROKE OUTCOME G. Ruiz-Ares1, B. Fuentes2, R. Hipola3, M. Martinez-Martinez4, P. Martinez-Sanchez5, E. Díez-Te-jedor6 Neurology Department. Stroke Centre. IdiPAZ Health Research Institute. La Paz University Hospital, Madrid, SPAIN1, Neurology Department. Stroke Centre. IdiPAZ Health Research Insti-tute. La Paz University Hospital, Madrid, SPAIN2, Neurology Department. Stroke Centre. IdiPAZ Health Research Institute. La Paz University Hospital, Madrid, SPAIN3, Neurology Department. Stroke Centre. IdiPAZ Health Research Institute. La Paz University Hospital, Madrid, SPAIN4, Neu-rology Department. Stroke Centre. IdiPAZ Health Research Institute. La Paz University Hospital, Madrid, SPAIN5, Neurology Department. Stroke Centre. IdiPAZ Health Research Institute. La Paz University Hospital, Madrid, SPAIN6 Background and purpose: The development of hyperglycemia has been associated with poor out-come in acute ischemic stroke. However, it is unknown how hyperglycemia also affects outcome in hemorrhagic strokes. Our objectives were to identify the capillary glucose threshold with the highest predictive accuracy of poor outcome and to evaluate its hypothetical value in predicting functional outcome by adjusting for other well-known prognostic factors in acute hemorrhagic stroke. Methods: A prospective and observational study including patients with hemorrhagic stroke within the first 24 hours from stroke onset. Capillary finger-prick glucose and stroke severity were deter-mined on admission and 3 times a day during 48 hours. Blood pressure monitoring and haemorrhage volume were recorded. Poor outcome (modified Rankin Scale >2) was evaluated at 3 months. Results: A total of 123 patients were included. The receiver operating characteristic curves showed the predictive value of maximum capillary glucose at any time within the first 48 hours point-ed to 150 mg/dl as the optimal cutoff level for poor outcome (62% sensitivity; 65% specificity; AUC=0.662; 95% CI, 0.565-0.759; P=0.003) and 153 mg/dl for mortality (73% sensitivity; 63% specificity; AUC=0.734; 95% CI, 0.600-0.868; P=0.003) at 3 months. Those points were associated with 4.030-fold increase (95% CI, 1.352 to 12.013) in the odds of dependency and 8.723-fold in-crease (95% CI, 1.664 to 45.710) in the odds of death after adjustment for age, maximum systolic and diastolic pressure levels, haemorrhage volume, baseline stroke severity, smoking and treatment with statins and hipotensor drugs. Conclusions: Hyperglycemia >150 or >153 mg/dL at any time within the first 48 hours from hemor-rhagic stroke onset is associated with higher dependency or mortality at 3 months respectively. 664 © 2013 S. Karger AG, Basel Scientific Programme 602 Acute stroke: emergency management, stroke units and complications Paramedic consent in the Paramedic Initiated Lisinopril For Acute Stroke Treatment (PIL-FAST) pilot trial L. Shaw1, C. Price2, S. McLure3, D. Howel4, E. McColl5, G.A. Ford6 Newcastle University, Newcastle upon Tyne, UNITED KINGDOM1, Northumbria Healthcare NHS Foundation Trust, Ashington, UNITED KINGDOM2, North East Ambulance Service NHS Trust, Newcastle upon Tyne, UNITED KINGDOM3, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM4, Newcastle University, Newcastle upon Tyne, UNITED KINGDOM5, New-castle University, Newcastle upon Tyne, UNITED KINGDOM6 Background PIL-FAST was a UK double-blind pilot randomised controlled trial where the first dose of medica-tion, sublingual lisinopril, was administered pre-hospital by paramedics. A novel two stage consent process was designed and used. Methods Paramedics were trained to use a script which incorporated a simple capacity assessment. A brief study description was followed by three questions to check understanding. If a patient answered the study questions correctly, they were asked to provide verbal consent to participate in the trial. If a patient was unable to answer the questions or appeared to lack mental capacity, a relative in atten-dance could provide verbal consent. More information about the study was given in hospital. Pa-tients or relatives were asked to confirm consent in writing. Results Fourteen participants were recruited (male n=7, median age = 73 yrs, median (IQR) NIHSS = 4 (3- 9)). For 10/14, verbal consent was given by the patient, for 1/14 a relative and for 3/14 paramedics recorded that both the patient and a relative had given verbal consent. Median time from paramedic arrival on scene to drug administration was 25 minutes. Written consent to continue in the trial was not obtained for 1 patient; a relative had provided consent in the ambulance but was distressed at hospital and unable confirm consent. One patient gave but then withdrew written consent because of concerns about lisinopril side effects. For the 3/14 patients where verbal consent pre-hospital was recorded as given by both patient and relative, written consent was given by the patient for 2/14 and a relative for 1/14. Median time from paramedic arrival on scene to hospital was 38 minutes; routine median scene to hospital time is 32 minutes. Conclusion The two stage consent process used in PIL-FAST was largely acceptable. A structured verbal con-sent process may be preferable for hyper-acute stroke trials and could be used in both pre-hospital and hospital settings.
Karger_ESC London_2013
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