22. European Stroke Conference 566 © 2013 S. Karger AG, Basel Scientific Programme 21 Acute stroke: emergency management, stroke units and complications Proximal arterial occlusion in acute ischemic stroke with low NIHSS scores should not be con-sidered as mild stroke J.-T. Kim1, M.-S. Park2, K.-H. Choi3, D.-S. Oh4, S.-H. Lee5, S.-M. Choi6, M.-K. Kim7, K.-H. Cho8, S.-R. Ryu9 Chonnam National University Hospital, Gwangju, SOUTH KOREA1, Chonnam National Uni-versity Hospital, Gwangju, SOUTH KOREA2, Chonnam National University Hospital, Gwangju, SOUTH KOREA3, Chonnam National University Hospital, Gwangju, SOUTH KOREA4, Chonnam National University Hospital, Gwangju, SOUTH KOREA5, Chonnam National University Hospital, Gwangju, SOUTH KOREA6, Chonnam National University Hospital, Gwangju, SOUTH KOREA7, Chonnam National University Hospital, Gwangju, SOUTH KOREA8, Chonnam National University Hospital, Gwangju, SOUTH KOREA9 Background: Previous studies demonstrated that patients with mild stroke have poor outcome when they do not receive thrombolysis. However, it is still unclear whether thrombolysis might be bene-ficial for acute mild stroke. We sought to investigate which factors would be associated with early neurological deterioration (END) and poor prognosis in patients with acute mild stroke. Methods: This was a retrospective study of consecutively registered patients with acute mild stroke (NIHSS ≤ 3) in our tertiary stroke center. END was defined as an increase in NIHSS ≥2 points between hospital days 0 and 5. The modified Rankin Scale (mRS) 0-1 at 90 days was defined as excellent outcome. Results: A total of 378 (mean age, 65.85+/-12.97 years) patients were included in this study. END occurred in 55 patients (14.6%). Relevant arterial occlusion on the initial MRA was in-dependently associated with END (OR, 2.206; 95% CI, 1.219-3.994; p = 0.009) and mRS >1 at 90 days (OR, 1.786; 95% CI, 1.085-2.940; p=0.022) by multivariate logistic regression. Of the 119 pa-tients with relevant arterial occlusion, ICA occlusion was independently associated with END (OR, 8.606; 95% CI, 2.312-32.043; p =0.001). Conclusions: This study demonstrates that relevant arterial occlusion could be an important predictor of END and poor outcomes at 3 months in patients with acute mild stroke. Therefore, acute stroke with relevant arterial occlusion should not be considered as mild stroke in acute periods. 20 Acute stroke: emergency management, stroke units and complications The impact of ambulance use on acute stroke care J. Minnerup1, H. Wersching2, M. Unrath3, K. Berger4 University of Münster, Münster, GERMANY1, University of Münster, Münster, GERMANY2, University of Münster, Münster, GERMANY3, University of Münster, Münster, GERMANY4 Background: Early treatment of acute stroke is associated with an improved outcome. Therefore am-bulance transport of stroke patients is recommended rather than self-transport. However, it remains unclear whether ambulance use leads to faster treatments. We investigated the effects of the trans-port mode on pre- and in-hospital processes of care. Methods: The present study was based on a prospective database of 158 hospitals of the Stroke Reg-ister of Northwestern Germany, which included 162,511 stroke patients admitted between January 2010 and December 2011. Baseline characteristics independently associated with the transport mode as well as the impact of the transport mode on the onset-to-door (OTD) times, the door-to-imaging (DTI) times and the thrombolysis frequency were analyzed. Results: Overall, 72.0% of the patients were transported by ambulance and 28.0% by self-trans-port. The baseline characteristics showing the strongest associations with ambulance use were the care situation (aOR, 7.81; 95%CI 6.86-8.90), a disturbed level of consciousness (aOR, 3.00; 95%CI 2.59-3.48) and having a subarachnoid (aOR, 2.79; 95%CI 2.24-3.49) or intracerebral hemorrhage (aOR, 2.26; 95%CI 1.92-2.67). For self-transport patients the probability of being in a higher OTD time category was 4.36 (95%CI 4.26-4.47) and the probability of being in a higher DTI time catego-ry was 1.32 (95%CI 1.28-1.36). Compared to self-transport, ambulance transport was independently associated with thrombolysis (aOR 1.95, 95%CI 1.77-2.15). Conclusion: Ambulance use was independently related to faster hospital arrival, to faster brain imag-ing and to thrombolysis. These findings strongly support that ambulance use improves stroke care.
Karger_ESC London_2013
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