22. European Stroke Conference 646 Acute stroke: emergency management, stroke units and complications Factors Influencing Onset-to-Door Duration following Acute Ischemic Stroke at a Singapore Tertiary Hospital M.S.H. Tan1, A.P. Ramaswami2, E.S.L. Ang3, S.S. Ho4, S.C. Ng5, F.P. Woon6, D.A. De Silva7 Duke-NUS Graduate Medical School, Singapore, SINGAPORE1, Singapore General Hospital, Singapore, SINGAPORE2, National Neuroscience Institute, Singapore, SINGAPORE3, National Neuroscience Institute, Singapore, SINGAPORE4, Singapore General Hospital, Singapore, 5, Singa-pore General Hospital, Singapore, SINGAPORE6, National Neuroscience Institute, Singapore, SIN-GAPORE7 Background: The majority of ischemic stroke patients cannot be considered for intravenous throm-bolysis within the 4.5 hour therapeutic window due to delayed hospital presentation. In Singapore, less than 5% of ischemic stroke patients receive thrombolysis. We aimed to study the duration be-tween symptom onset to hospital arrival and factors associated with presentation delay among isch-emic stroke patients in Singapore. This will help in developing strategies to raise stroke awareness and reduce presentation delays. Methods: In this prospective study, we included consecutive isch-emic stroke patients who presented within 2 weeks of symptom onset to a single tertiary hospital in Singapore in 2012. Results: Of 771 patients studied, 17.9% presented within 3.5 hours, 12.3% from 3.5–8 hours, 9.7% from 8–12 hours, and 60.1% after 12 hours. A higher proportion of patients with atrial fibrillation (AF) (28.6% vs 16.5%; p<0.005) and older patients (≥80years) (26.2% vs 16.6%; p=0.02) presented within 3.5 hours. Only 18.4% patients with previous stroke presented within 3.5 hours, similar to those with no history of stroke (17.3%). Conclusion: Despite Singapore’s small land area, close proximity and easy access to hospitals, only a minority of ischemic stroke patients arrived at hospital within the thrombolytic time window (taken as 3.5 hours to account for a 1 hour door-to-needle duration). Even if time windows are extended to 8 hours, only an additional small proportion (12.3%) may be eligible for thrombolysis. The proportion of onset-to-door delays is sim-ilar to results from our 2004 survey, demonstrating no improvement over 8 years and suggesting an urgent need for more effective public health education strategies. Most patients with known stroke risk such as those with AF and previous stroke also had delayed hospital presentation, indicating a missed opportunity for stroke awareness education of high risk individuals. 688 © 2013 S. Karger AG, Basel Scientific Programme 647 Acute stroke: emergency management, stroke units and complications Should MRI be first choice of imaging for stroke? J. Ganesalingam1, E. Abdelgadir2, A. Kar3, S. Banerjee4, S. Buddha5, D. Ames6, O. Halse7 Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM1, Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM2, Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM3, Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM4, Department of Stroke Medicine, Imperial College Health-care NHS Trust, London, UNITED KINGDOM5, Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM6, Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UNITED KINGDOM7 BACKGROUND: MRI has increased in utilisation over the last decade and has supplemented rath-er than replaced CT for investigation of patients presenting with a stroke. Imaging is the fastest growing component of hospitalisation cost for stroke. AIMS: To identify if MRI as the first choice of imaging modality leads to clinical benefits and potential reductions in length of hospital admis-sions and reduction of stroke mimics being admitted. METHODS: Retrospectively, the number and type of imaging for 300 patients admitted to the stroke unit were recorded. Prospectively, data was collected on 70 patients with an eventual diagnosis of a posterior circulation stroke or categorised as having a stroke mimic. Cases were discussed with a stroke consultant to give an estimate on the potential reduction in length of stay. RESULTS: From the retrospective analysis, 26% of admissions were stroke mimics and therefore would have been prevented from being admitted to the stroke unit. 39% of patients had more than one brain scan. From the prospective analysis, the 20 patients with a final diagnosis of a posterior circulation stroke demonstrated a potential reduction in a total of 20 days on stroke unit over a 2 month period. For the 50 patients with a final diagnosis classified as a stoke mimic, there was a potential reduction in 114 days on the stroke unit over a 2 month period. DISCUSSION: MRI as 1st choice of imaging for those presenting clinically as a stroke will result in the correct identification of stroke mimics allowing admission under the appropriate medical team. In addition, financial savings would be made through avoidance of repeated imaging. The reductions in length of stay would ease pressure on increasing burden on hospital beds
Karger_ESC London_2013
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