Page 117

Karger_ESC London_2013

London, United Kingdom 2013 20 Acute stroke: emergency management, stroke units and complications B 12:10 - 12:20 Reducing in-hospital delay in stroke thrombolysis: experience in a tertiary hospital emer-gency Cerebrovasc Dis 2013; 35 (suppl 3)1-854 117 department in China X. Cheng1, Y. Ling2, K. Fang3, H. Liu4, Z. Hu5, Q. Dong6 Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan Universi-ty, Shanghai, CHINA1,Department of Neurology and Institute of Neurology, Huashan Hospi-tal, Fudan University, Shanghai, CHINA2, Department of Neurology and Institute of Neurolo-gy, Huashan Hospital, Fudan University, Shanghai, CHINA3, Department of Nursing, Huashan Hospital, Fudan University, Shanghai, CHINA4, Emergency Department, Huashan Hospital, Fudan University, Shanghai, CHINA5, Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, CHINA6 Background: Efficacy of thrombolytic therapy for ischemic stroke decreases with time elapsed from symptom onset. Results from China National Stroke Registry showed that in-hospital delay resulting in time window beyond 3 hours is the most common reason for not giving in-travenous thrombolysis in patients arriving within 3 hours of symptom onset. We hope that optimizing our emergency thrombolytic protocols could reduce in-hospital delays. Methods: A series of interventions to reduce treatment delays were implemented since July 2011. In-hospi-tal delays were analyzed as annual median door to needle time (DNT) in minutes and the rate of DNT≤60 minutes. Results: A total of 2,564 patients with cerebral infarction were admitted be-tween January 2008 and December 2012, 113 patients received intravenous thrombolytic thera-py. The median age was 68 year-old (interquartile range IQR: 57-74) and 64.6% were males. The baseline median National Institutes of Health Stroke Scale (NIHSS) score was 10(IQR 6-14). Percentage of thrombolytic use was increased from 1.9% to 9.2% (P<0.001). Median DNT was reduced from 100 minutes (IQR 86-112) to 74 minutes (IQR 55-99) (P<0.001). Rate of DNT ≤ 60 minutes was increased from 6.5% to 34.1% (P=0.003). Conclusions: Achieving DNT≤60 minutes for the majority of thrombolytic therapy candidates is still our goal. Further simplifying the thrombolytic procedures to treat the patients faster will help us to achieve this goal in the future. 19 Acute stroke: emergency management, stroke units and complications B 12:00 - 12:10 Factors Influencing Door-To-Imaging Time: Analysis of the SITS-EAST Registry M. Harsany1, P. Kadlecova2, V. Svigelj3, J. Korv4, V.B. Kes5, A. Vilionskis6, Y. Krespi7, R. Mikulik8 International Clinical Research Center - Neurology Department, St. Anne´s Hospital in Brno and Masaryk University, Brno, CZECH REPUBLIC1,International Clinical Research Center, St. Anne´s Hospital in Brno, Brno, CZECH REPUBLIC2, Department of Vascular Neu-rology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Ljubljana, SLOVENIA3, Department of Neurology and Neurosurgery, University of Tartu, Tartu, ESTONIA4, Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zagreb, CROATIA5, Department of Neurology and Neurosurgery, Vilnus University and Republican Vilnius University Hospital, Vilnius, LITHUANIA6, Memorial Hospital Stroke Rehabilitation and Research Center, Istanbul, TURKEY7, International Clinical Research Cen-ter - Neurology Department, St. Anne´s Hospital in Brno, Brno, CZECH REPUBLIC8 Background: Brain imaging is necessary and also logistically the most difficult task before thrombolysis. To improve door-to-needle time (DNT), it is therefore important to understand if 1) longer door-to-imaging time (DIT) results in longer DNT, 2) hospitals have different per-formance with respect to DIT, and 3) patient and hospital characteristics predict DIT. Methods: Prospectively collected data in the Safe Implementation of Treatments in Stroke EAST regis-try from Central/Eastern European countries between 2008 and 2011 were analyzed. Hospital characteristics were obtained through questionnaire from each center. DIT≤25 minutes was selected as the outcome based on previous reports and recommendations. Patient- and hospi-tal- level independent predictors of DIT≤25 min were identified by general estimation equations method. Results: Hospital characteristics were obtained from 6 of 9 SITS-EAST countries, where 4212 patients were treated with thrombolysis within 4.5 hours of symptom onset. After excluding patients with missing values, 3631 (86%) were further analyzed. A DIT≤25 minutes was accomplished in 2464 (68%) patients. In different centers, rate of patients with DIT ≤25 min ranged from 3 to 93% (median 65%, IQR 50-80%). Patients with DIT≤25 min had shorter DNT (median 60 min) than patients with DIT>25 min (median 86 min; p <0.001). Following variables independently predicted DIT≤25 min: longer time from stroke onset to admission (onset-to-admission time 91-180 versus 0-90 min, OR 1.6; 95%CI 1.3 to 1.8), then distance be-tween place of admission to hospital and CT scanner ≤5 min (OR 2.9; 95%CI 1.7 to 4.7), no or minimal neurological deficit before stroke (OR 1.3, 95%CI 1.02 to 1.5), and diabetes mellitus (OR 0.8, 95%CI 0.7 to 0.97). Conclusion: DIT can be improved in many centers and especially in patients arriving to hospital early after stroke symptom onset. Place of admission to hospital should be closer than 5 minutes of transportation time to CT scanner.


Karger_ESC London_2013
To see the actual publication please follow the link above