London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 687 644 Acute stroke: emergency management, stroke units and complications Natural course of urinary retention in acute stroke O.M. Rønning1, A. Benterud2 Stroke Unit, Akershus University hospital, Lørenskog, NORWAY1, Stroke Unit, Akershus Uni-versity hospital, Lørenskog, NORWAY2 Background: Urinary retention in acute stroke is common and urinary tract infections are among the most frequent complications the first week after stroke. Intermittent catheterization (IC) is recom-mended in retention but it is not known which volume of residual urine that should initiate IC. As catheterization increases the risk of urinary tract infections, is time consuming and may be associat-ed with discomfort IC should be performed when necessary. Most acute stroke patients with urinary retention have regained their bladder function within the first one or two weeks. Aim of this study was to explore the natural course of urinary retention the first week after acute stroke. Methods: Acute stroke patients were screened for urinary retention after spontaneous voiding. If bladder scan showed more than 50 ml of residual urine volume (RUV) patients were included for follow up. Patients were catheterized immediately when retention was detected and if retention caused discomfort. Results: In total 166 acute stroke patients with a mean age of 76.3 years (range 26-97) with urinary retention were followed with repeated bladder ultrasound during hospitalisation. Mean RUV on admission was 338 ml (range 53-942 ml). On admission 105 patients (63%) with a mean RUV of 413 ml were catheterized and 61 patients (37%) with a mean RUV of 208 ml were followed with repeated bladder examinations. In total 24% still needed IC one week after stroke. In a regression analysis URV and cahteterization on admission (p=0.03 and p<0.0001) predicted IC one week after stroke. Conclusion: A large proportion of stroke patients with urinary retention on admission do not need catheterization one week after stroke. Residual urine volume and require of catheterization on ad-mission predicts need of catheterization one week after acute stroke. 645 Acute stroke: emergency management, stroke units and complications Stroke-Mimics: The Experience at an East London Hyper-Acute Stroke Unit Centre S.E. Shribman1, A. Khan2, J. Williamson3, N. Vaid4, D. Ip5, P. Gompertz6 Barts Health NHS Trust, London, UNITED KINGDOM1, Barts Health NHS Trust, London, UNITED KINGDOM2, Barts Health NHS Trust, London, UNITED KINGDOM3, Barts Health NHS Trust, London, UNITED KINGDOM4, Barts Health NHS Trust, London, UNITED KINGDOM5, Barts Health NHS Trust, London, UNITED KINGDOM6 Background: Since 2010 all suspected strokes in London are transferred to 1 of 8 Hyper-Acute Stroke Units (HASU). The national stroke audit suggests that 20% of HASU referrals are stroke-mimics. There is limited data on the nature of mimic admissions at HASU centres. Methods: A service evaluation of mimics referred to the HASU at the Royal London Hospital (RLH) was conducted over four weeks. A range of data on those shown to be mimics, including FAST/ROSI-ER scores, was retrospectively collected. Results: 28% of 103 referrals to the HASU were mimics. This is not significantly different to national rates. 55% of these mimics were referred by paramedics but only 40% of the remaining referrals, from a different emergency department (ED) or a gener-al practitioner, were FAST positive. 86% of mimics lived local to a different ED. Approximately a third were referred on to the RLH acute medicine team, a third were admitted by the HASU team with a third discharged at presentation. The latter were younger (mean 40.7 years) than those ad-mitted under the acute medicine team (mean 71.1 years). Of the mimics, sepsis (6.9%) and seizures (13.8%) were managed under the acute medicine team and migraine (24.1%), functional disorder (20.7%) and syncope (10.3%) were managed by the HASU team. The mean length of admissions was 2.1 days and the maximum was 13 days. The mortality rate was 6.9%. Medical record keeping was suboptimal in some cases. Conclusions: This service evaluation has characterised the nature of stroke-mimics referrals to an East London HASU and there are two key findings: Firstly, there are inappropriate referrals (FAST/ROSIER negative) from local EDs to the RLH HASU and this high-lights the need to emphasise the importance of FAST/ROSIER scores to local EDs. Secondly, whilst the mean length of admission is low there is a wide range suggesting that repatriation could be con-sidered in those few patients that are likely to have prolonged admissions and do not live locally.
Karger_ESC London_2013
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