22. European Stroke Conference 604 Acute stroke: emergency management, stroke units and complications Thrombolysis in acute stroke in the Royal Hallamshire Hospital, Sheffield. Evaluating perfor-mance and learning lessons. E.V. Hobson1, K. Endean2, C. Longford3, M. Randall4, G. Venables5 Sheffield Teaching Hospitals NHS Trust & Sheffield Institute for Translational Neurosciences, Sheffield University, Sheffield, UNITED KINGDOM1, Sheffield Teaching Hospitals NHS Trust, Sheffield, UNITED KINGDOM2, North Trent Stroke Strategy Project, North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium (NORCOM)., Barnsley, UNITED KING-DOM3, Sheffield Teaching Hospitals NHS Trust, Sheffield, UNITED KINGDOM4, Sheffield Teach-ing Hospitals NHS Trust, Sheffield, UNITED KINGDOM5 Background Thrombolysis in acute stroke improves outcomes but benefits are greater the earlier treatment is commenced. A thrombolysis service must provide rapid assessment and treatment face-to-face (F2F) or using telemedicine (TM). An efficient service requires regular evaluation and develop-ment. 666 © 2013 S. Karger AG, Basel Scientific Programme Methods The thrombolysis service at the Royal Hallamshire Hospital (Sheffield, UK) was evaluated. 933 patients were admitted during the 13 months from June 2011 to June 2012, 55% were admitted out of working hours. The performance of thrombolysis provided F2F and by TM was compared using Mann Whitney analysis. The 44 patients who received thrombolysis F2F were compared to the 11 patients who received thrombolysis out-of-hours using the South Yorkshire regional TM service be-tween January 2012 and June 2012. Results Median door-to-needle time was significantly slower using TM than F2F (99 minutes TM vs. 77 minutes F2F, p=0.0041). There was no difference in the time taken present to hospital or transfer to CT but the time between CT and treatment (during which the TM consultation occurred) was signifi-cantly longer (80.5 minutes TM vs. 43.5 minutes F2F, p=0.0007). Time from onset to treatment was significantly longer using TM (194 minutes TM vs. 155 minutes F2F p=0.032). 64% of patients treated using TM were treated more than 3 hours after symptom onset compared to 42% in the F2F group. Median age and stroke severity were not significantly different. In our hospital thrombolysis F2F or using TM is slower than the Safe Implementation of Thrombol-ysis in Stroke-Monitoring Study average (59 minutes). The thrombolysis pathway was analysed and suggestions for improvement were made. Conclusion Telemedicine can provide access to specialist assessment and thrombolysis in acute stroke but it causes delays to treatment. For units that provide thrombolysis, analysis of the pathway, identifica-tion of delays and targeted improvement can improve services. 605 Acute stroke: emergency management, stroke units and complications VALIDATION OF THE “STROKE PROGNOSTICATION USING AGE AND NIHSS” (SPAN) INDEX IN A COHORT OF ISCHAEMIC STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS S. Abilleira1, H. Quesada2, M. Rubiera3, M. Castellanos4, M. Vargas5, M. Gomis6, J. Krupinski7, R. Delgado-Mederos8, M. Gómez-Choco9, E. Giralt10, M.C. Garcia11, A. Pellisé12, F. Purroy13, M. Garcés14, A. Ribera15 on behalf of the Catalan Stroke Code and Reperfusion Consortium (Cat-SCR) Stroke Programme. Catalan Agency for Health Information, Assessment and Quality. De-partment of Health (Catalonia), Barcelona, SPAIN1, Cat-SCR members, L’Hospitalet, SPAIN2, Cat-SCR members, Barcelona, SPAIN3, Cat-SCR members, Girona, SPAIN4, Cat-SCR members, Barcelona, SPAIN5, Cat-SCR members, Badalona, SPAIN6, Cat-SCR members, Terrassa, SPAIN7, Cat-SCR members, Barcelona, SPAIN8, Cat-SCR members, Sant Joan Despí, SPAIN9, Cat-SCR members, Barcelona, SPAIN10, Cat-SCR members, Sabadell, SPAIN11, Cat-SCR members, Tarragona, SPAIN12, Cat-SCR members, Lleida, SPAIN13, Cat-SCR members, Tortosa, SPAIN14, Stroke Programme. Catalan Agency for Health Information, Assessment and Quality. Department of Health (Catalonia), Barcelona, SPAIN15 Background: Age and NIHSS are major predictors of stroke outcomes. We aimed to validate the recently published SPAN-100 score in a large cohort of AIS patients undergoing intravenous throm-bolysis (IVT). Methods: We used data from the SONIIA register, a mandatory register ongoing from Jan 1st 2011, which monitors the quality of all reperfusion therapies administered in Catalonia under routine prac-tice conditions. Seventeen hospitals administer IVT and include relevant data in the register. The SPAN-100 index combines age (years) and NIHSS of any given patient and it is positive if => 100. We compared crude and adjusted rates of SICH (SITS-MOST definition) at 24-36 hours, mortality and functional outcome at 3 months between SPAN-100 negative and positive cases. We determined the area under the ROC curve for prediction of outcomes based on the SPAN index. Results: We studied 1302 IVT-treated patients, of whom 84.3% were SPAN-100 negative. SICH was not different between groups. Proportion of patients with mRS 0-1 and 0-2 at 3 months was signifi-cantly reduced in SPAN-100 positives (9.4% vs. 47.3%, and 14.9% vs. 63.2%; p< 0.001), whereas the death rate was significantly higher (39% vs. 10%; p< 0.001). The area under the ROC curve for the prediction of mRS and mortality at 3 months was 0.79 and 0.77, respectively. Specificity and sensitivity for SPAN =>100 were 95.8% and 30% for mRS >2, and 88.8% and 42.3% for mortality. Adjusting by baseline patient characteristics and time to treatment, the SPAN-100 positives had a 5-fold increased odd of death (95% CI: 3.4-7.1) and an 8-fold increased risk of mRS> 2 (95% CI: 5.2-12.9). Conclusion: The SPAN-100 index is a simple, straightforward method to estimate clinical outcomes among patients undergoing IVT. It might be used to select IVT candidates among those meeting the “Principle of Doubt”.
Karger_ESC London_2013
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