London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 705 678 Acute stroke: clinical patterns and practice Concurrent validity of two nutrition screening tools in acute stroke patients V.C. Aubrey1, F. Gomes2, C.E. Weekes3 King’s Collage London, London, UNITED KINGDOM1, King’s Collage London, London, UNITED KINGDOM2, Guy’s and St Thomas’ NHS foundation trust, London, UNITED KING-DOM3 Introduction There is a continued high prevalence and lack of recognition of malnutrition in hospi-tals. Nutrition screening tools (NSTs) are used to identify those at risk of malnutrition who may ben-efit from intervention. This study was used to assess the concurrent validity of two NSTs in stroke patients. Method Patients admitted to St Thomas’ Hospital with acute stroke were assessed using two NSTs; MUST (Elia, 2003) and Guy’s & St Thomas’ (GST) (Weekes et al 2004) if they were in hospital more than 3 days. Both tools include three variables (BMI, weight loss and nil by mouth over 5 days). MUST requires calculation of % weight loss whereas the GST simply requires a record of weight loss with no requirement to calculate % change. An extra variable (decreased appetite) is included in GST. Both tools assign patients to one of three categories (low, medium or high risk of malnutrition). Agreement between the methods was tested using the Kappa statistic, a chance cor-rected measure of agreement where k > 0.6 represents good agreement (Landis & Koch 1977). Sta-tistical tests were conducted using SPSS (v 18). Results NSTs were completed for all subjects using GST (n = 158) and 154 (97 %) using MUST due to missing information for % weight loss. Data were analysed on 154 patients; 77 males (50%); mean age 72.3 (SD 13.9) years; BMI 25.7 (SD 6.1) kg/m2; NIHSS score 10.2 (SD 6.4). There was complete agreement between the tools in 132 pa-tients (85.7%) and chance corrected agreement between the tools was good (= 0.746, SE 0.046) (see Table 1). Although agreement between the tools was good, the GST classified more patients in the higher risk categories. Conclusion This study suggests good concurrent validity between the MUST and GST screening tools. Completion of MUST was not possible in a small proportion of cases. Agreement between these tools suggests either MUST or GST can be used to assess nutritional risk status in acute stroke patients. Elia M (2003) BAPEN Landis JR & Koch GG (1977) Biometrics 33: 159-74 Weekes CE et al (2004) Clinical Nutrition, 23:1104-12 Table 1: Concurrent validity of two NSTs Low GST Medium High Low 72 10 2 MUST Medium 4 2 4 High 0 2 58 679 Acute stroke: clinical patterns and practice Variation in care between patients with thrombolysed ischaemic stroke, non-thrombolysed ischaemic stroke and haemorrhagic stroke L. Paley1, J.T. Campbell2, B. Bray3, S. Kavanagh4, A.M. Hoffman5, M. James6, G. Cloud7, P. Tyr-rell8, A.G. Rudd9 Royal College of Physicians, London, UNITED KINGDOM1, Royal College of Physicians, Lon-don, UNITED KINGDOM2, King’s College London, London, UNITED KINGDOM3, Royal Col-lege of Physicians, London, UNITED KINGDOM4, Royal College of Physicians, London, UNITED KINGDOM5, Royal Devon and Exeter NHS Foundation Trust, Exeter, UNITED KINGDOM6, St George’s Healthcare NHS Trust, London, UNITED KINGDOM7, University of Manchester, Man-chester, UNITED KINGDOM8, Guy’s and St Thomas’ NHS Foundation Trust, London, UNITED KINGDOM9 Background: Over recent years many stroke services have developed fast track services for stroke thrombolysis. Focusing care pathways around thrombolysis may exclude other groups of patients who might also benefit from rapid access to specialist stroke care. We aimed to identity if patients with ischaemic stroke who did not receive thrombolysis (tPA) or those who had a haemorrhagic stroke received the same process of care as patients treated with thrombolysis. Methods: Data were extracted from the Stroke Improvement National Audit Programme (SINAP) of adults with acute stroke admitted to a participating hospital in England from January 2011-Sep-tember 2012. Achievement of the processes of care in the first 72 hours of admission were compared across three groups: ischaemic stroke treated with tPA, ischaemic stroke not treated with tPA and haemorrhagic stroke. Results: Of 58 459 adults admitted with acute stroke to 110 hospitals, 6333 (10.8%) had a haem-orrhagic stroke, 5683 (9.7%) had ischaemic stroke treated with tPA and 46 443 (79.4%) had isch-aemic stroke not treated with tPA. A greater proportion of patients treated with tPA were admitted to a stroke unit within 4 hours of hospital arrival (86%) compared to those with ischaemic stroke not treated with tPA (59%) or haemorrhagic stroke (53%), Chi2 p<0.0001. A similar pattern was observed for being seen by a stroke consultant within 24 hours (97%, 82%, 78% respectively, Chi2 p<0.0001). Overall, patients treated with tPA had higher achievement of 11 of the 12 key indicators of care quality reported in SINAP. Conclusions: Patients treated with tPA are both more likely to receive timely specialist stroke care than patients not receiving tPA or those with haemorrhagic stroke. Providing the most timely care should be possible for all patients admitted with stroke and may improve outcomes in patients not treated with tPA.
Karger_ESC London_2013
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