22. European Stroke Conference 14 Acute stroke: emergency management, stroke units and complications B 11:10 - 11:20 Reduction of In-Hospital Delays in Stroke Thrombolysis: SITS-WATCH D. Strbian1, N. Wahlgren2, R. Mikulik3, C. Price4, W. Lang5, A. Davalos6, P. Ringleb7, N. Kostulas8, M. Uyttenboogaart9, N. Ahmed10, T. Tatlisumak11 Helsinki University Central Hospital, Helsinki, FINLAND1,Karolinska Institutet, Stock-holm, SWEDEN2, International Clinical Research Center - Neurology Department, St. Anne´s Hospital in Brno, Brno, CZECH REPUBLIC3, Newcastle University, Newcastle, UNITED KINGDOM4, , Vienna, AUSTRIA5, , Barcelona, SPAIN6, Heidelberg University, Heidelberg, GERMANY7, Karolinska Institutet, Stockholm, SWEDEN8, University of Groningen, Gronin-gen, THE NETHERLANDS9, Karolinska Institutet, Stockholm, SWEDEN10, Helsinki University Central Hospital, Helsinki, FINLAND11 Background In patients with acute ischemic stroke: the sooner the thrombolysis treatment is adminis-tered after symptom onset – the better the outcome. This delay can be dissected into onset-to-door time and door-to-needle time (DNT). Of the two, DNT can be directly influenced by streamlining of acute stroke care. We launched the SITS-WATCH project to minimize DNT in centers contributing to-wards the SITS registry. Methods An itemized detailed questionnaire including factors known to influence DNT was sent to all SITS centers to identify the reasons for long in-hospital delays. Based on the replies from centers willing to participate in SITS-WATCH, we prepared a list of interventions that could be considered in order to reduce DNT (assuming these were permitted by national legis-lation). The current DNT was analyzed. Results Median of DNT in all SITS centers is 65 minutes without any major change within the last 10 years, whereas it was 75 minutes in the last 3 years for 94 centers from 27 countries willing to partici-pate in SITS-WATCH (compared with 20 minutes in Helsinki center). Based on the itemized question-naire, we identified several possible actions to reduce DNT, the most important of which are: 1) Pre-notification by the Emergency Medical Service (EMS) person-nel, directly to dedicated stroke physician. 2) EMS personnel obtain basic laboratory and vital parameters, one-lead ECG, and insert an IV line with a large-bore needle during transport. 3) During transport, order all necessary laboratory tests and imag-ing, and review electronic chart records (history, medications, recent laboratory results, possible con-traindications). 4) Imple-ment point-of-care INR. 5) Empty the CT room prior to patient’s arrival, trans-port the patient from ambulance directly to CT room, where you deliver thrombolysis. Conclusion SITS-WATCH centers will be provided with recommendations to reduce DNT and the impact of implementation will be assessed. 13 Acute stroke: emergency management, stroke units and complications B 11:00 - 11:10 Outcome after Decompressive Hemicraniectomy in Right versus Left Hemispheric Malig-nant Middle Cerebral Artery Infarction R. Bhatia1, V. Rai2, S. Singh3, M.V. Padma4, K. Prasad5, A. Suri6, M. Tripathi7, M.B. Singh8 All India Institute of Medical Sciences, New Delhi, INDIA1,All India Institute of Medical Sciences, New Delhi, INDIA2, All India Institute of Medical Sciences, New Delhi, INDIA3, All India Institute of Medical Sciences, New Delhi, INDIA4, All India Institute of Medical Scienc-es, New Delhi, INDIA5, All India Institute of Medical Sciences, New Delhi, INDIA6, All India Institute of Medical Sciences, New Delhi, INDIA7, All India Institute of Medical Sciences, New Delhi, INDIA8 Background Decompressive hemicraniectomy (DC) in malignant middle cerebral artery (MCA) infarction reduces mortality significantly. Data comparing outcomes in either hemispheric in-farction is however limited. We aimed to study outcome differences following hemicraniectomy between right and left malignant MCA hemispheric infarction Methods All patients undergoing DC for malignant MCA infarcts were prospectively enrolled. Details of demographics, baseline risk factors and surgery were noted. All patients were followed up for one year to assess out-comes. Modified Rankin score (mRS) of ≤4 was defined as a good outcome. Results 36 patients underwent DC. There were 20 patients with right (group1) and 16 patients with left (group2) hemispheric infarction. There was no difference in mean age, sex, time from onset to surgery, GCS, midline shift, cause of stroke, risk factors of stroke or duration of ICU and hospital stay between the two groups. Mean NIHSS at admission in group 1 was 17.63±3.2 as compared to 20.6±2.7 in group 2;p=0.006. Good outcome at one year was achieved by 45% (9/20) patients in group 1 as compared to 62% (9/16) in group 2;p=0.651. Mortality at one year follow up was 55% (11/20) in group1 and 25% (4/16) in group 2;p =0.07. Odds of death one year after stroke were 3.66 times greater among patients with right hemispheric malignant MCA infarction as compared to left; p value= 0.076 ( 95% CI, 0.87 – 15.3 ). Conclusion No difference in longterm good outcome was observed in either hemispheric infarctions after decompressive hemicra-niectomy. More patients were severely disabled or died with right hemispheric infarctions. De-compressive hemicraniectomy should be offered as a lifesaving surgery to either hemispheric infarction. 114 © 2013 S. Karger AG, Basel Scientific Programme
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