London, United Kingdom 2013 Poster Session Nurses/AHP’s Cerebrovasc Dis 2013; 35 (suppl 3)1-854 199 2006 Acute stroke: clinical patterns and practise including nursing Outcome of stroke patients requiring feeding by Percutaneous Endoscopic Gastrostomy (PEG) tubes M. Lehmkuhl1, G. Walløe2, T.S. Olsen3 The Stroke Unit, Frederiksberg University Hospital, Frederiksberg, DENMARK1, The Stroke Unit, Frederiksberg University Hospital, Frederiksberg, DENMARK2, The Stroke Unit, Frederiks-berg University Hospital, Frederiksberg, DENMARK3 Background: Tube feeding may be a prerequisite for survival of patients with severe stroke. How-ever, survival may be at the expense of surviving with poor outcome raising ethical as well as legal issues. Methods: We registered all patients with stroke and dysphagia admitted to a Copenhagen stroke unit within a 9 years period in which a Percutaneous Endoscopic Gastrostomy (PEG) tube was inserted. We recorded age, sex, admission and discharge functional status (Barthel index (BI) (0-20)), time from stroke until tube feeding was instituted (nasogastric tube followed by PEG tube), and discharge destination. In case of nursing home discharge patients were considered being without any further rehabilitation potential. Results: In total, 34 patients had a PEG tube. Mean age was 78 years (range 57–94 years), 22 were women. Mean admission BI was 0 (range 0-4). Mean length of hospital stay was 60 days (range 8-191 days). Of the 34 patients 3 died in hospital, 28 were discharged to nursing home and 3 were discharged to own home. Mean discharge BI was 1 (range 0-6).Within the 9 years period 27 had died; mean survival time was 607 days (range 34-2217 days). Tube feeding was instituted mean 2 days (range 0-16 days) from stroke onset. PEG tube was instituted mean 46 days (range 12-183 days) from stroke onset. Conclusion: Outcome of patients with stroke and PEG tube was very poor; 91% died or were dis-charged to nursing home totally dependent, incontinent and immobile as mean discharge BI was only 1. Although lifesaving decisions on PEG placement in severe stroke is not straight forward and should include reflections of ethical and existential character. 2007 Acute stroke: clinical patterns and practise including nursing An Emergency Medicine Department-Based Nurse Clinician-Run TIA Acute Management Programme: Patient Characteristics and Outcome L.L.E. Tay1, P.F.A. Sam2 National University Hospital, Singapore, Singapore, SINGAPORE1, National University Hospi-tal, Singapore, Singapore, SINGAPORE2 Objective: Transient ischaemic attack (TIA) requires emergent evaluation and management due to high early recurrent stroke risk, but hospitalisation may not be necessary. We aim to evaluate our experience in using an emergency medicine department (EMD)-based nurse clinician-run TIA acute management programme. Methods: Patients with TIA or minor stroke presented to the EMD during office hours were first seen by emer-gency physicians and those not requiring immediate hospitalisation were referred to a nurse clini-cian for detailed history taking and examination. The nurse clinician then discussed with the stroke neurologist on the plan of initial investigation and management; and again after all blood and im-aging results were reviewed on the final diagnosis, discharge plan, short-term management and fol-low- up appointments. Prospective data were collected on patient characteristics and outcome up to 3 months. Findings: 156 patients were seen from Oct 2011 to Sep 2012, 55.8% were male, and their mean(SD) age was 53.9(13.5) years. Presence of risk factors included hypertension 60.9%, diabetes mellitus 21.8%, hyperlipidaemia 62.8%, smoking 22.4%, previous stroke/TIA 16.7%, IHD 12.8% and AF 3.2%. Dis-tribution of ABCD2 scores were 0-1: 37.2%, 2-3: 20.5%, 4-5: 35.9%, 6-7: 6.4%. 18 patients (11.5%) were admitted whereas the rest were managed and discharged from EMD. After reviewing all in-formation, 46 patients (41.8%) were unlikely to have TIA or had alternative diagnoses; their mean ABCD2 was 0.96 (range 0-5) and they had no recurrent event within 3 months. For the 110 patients with minor stroke, TIA or possible TIA; mean ABCD2 was 3.27 (range 0-7) and recurrent event rates were 0% at 2 days, 0.9% at 7 days (1 stroke) and 2.7% at 3 months (2 additional TIA). Conclusion: A nurse clinician-run EMD-based acute management programme for TIA, with support from EMD physicians and stroke neurologist, is effective in reducing hospitalisation and achieving a low recur-rent stroke rate.
Karger_ESC London_2013
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