22. European Stroke Conference 568 © 2013 S. Karger AG, Basel Scientific Programme 25 Acute stroke: emergency management, stroke units and complications Low rate of interhospital transfers within an integrative telestroke network (TEMPiS) P. Müller-Barna1, G. Hubert2, S. Boy3, R. Backhaus4, F. Schlachetzki5, R.L. Haberl6 Städtisches Klinikum München GmbH, Munich, GERMANY1, Städtisches Klinikum München GmbH, Munich, GERMANY2, University of Regensburg, Regensburg, GERMANY3, University of Regensburg, Regensburg, GERMANY4, University of Regensburg, Regensburg, GERMANY5, Städtisches Klinikum München GmbH, Munich, GERMANY6 Introduction: Telestroke hospitals do not provide the broad spectrum of neurological and neurosurgical care, therefore additional need for interhospital transfers to stroke centres may occur. The average rate of interhospital transfer of patients with acute stroke in Bavaria is 6.8% (stroke registry BAQ; year 2011). The Telemedical Project of Integrative Stroke Care (TEMPiS) in Germany aims to provide high standard stroke care in non-urban areas by setting up telestroke units in the network hospitals, implementing a 24/7 teleconsultation service, internal guidelines, and education programs. In this study, we analysed the rates and indications for interhospital transfers in the TEMPiS network. Methods: All teleconsultations with a recommendation for an interhospital transfer in 2012 within the TEMP-iS network were analysed according to diagnoses and reasons for transfer. Results: 4,688 teleconsultations were performed in 2012. In 317 cases (6.8%) transfer was recommended. Transfers were recommended due to a vascular cause in 219 (69%), and a non-vascular cause in 60 patients (19%). Diagnosis remained unclear at the time of teleconsultation in 38 patients (12%) (ta-ble 1). Reason for transfer was neurosurgical in 148 (47%), acute thrombectomy in 67 (21%) and specialized neurological treatment in 101 (32%) cases, of the latter only 29 patients had a diagnosis of stroke (table 2). The average transport distance was 64km. Transportation was ambulance or heli-copter as available and appropriate. Conclusion: Due to the structure of the integrative stroke network including telestroke units most patients can be treated locally (93.2%) without the need for transfer. Transfer rates are similar to the rates of the hospitals taking part in the Bavarian Stroke Registry. The most common cause for transfer is the need for neurosurgical procedures. Transfer for stroke patients without need for neurosurgery or thrombectomy is very rare. 24 Acute stroke: emergency management, stroke units and complications Variability of estimated acute stroke onset times among physicians in the Emergency Depart-ment T.J. Ingall1, M.I Aguilar2, B. Demaerschalk3, D. Capampangan4, D.W. Dodick5, T. Kiernan6, J. Lee-Iannotti7, B. Vargas8, H. Yancy9 Mayo Clinic Arizona, Phoenix, USA1, Mayo Clinic Arizona, Phoenix, USA2, Mayo Clinic Arizo-na, Phoenix, USA3, Mayo Clinic Arizona, Phoenix, USA4, Mayo Clinic Arizona, Phoenix, USA5, Mayo Clinic Arizona, Phoenix, USA6, Mayo Clinic Arizona, Phoenix, USA7, Mayo Clinic Arizona, Phoenix, USA8, Mayo Clinic Arizona, Phoenix, USA9 Background: IV tPA is an effective treatment when administered within 4.5 hours of ischemic stroke onset. Whether acute stroke treatment is given depends on medical personnel determining when stroke patients (SP) were last known to be well (LKTBW). This study assessed the variation among physicians in determining when SPs were LKTBW. Methods: Data were collected on all suspected SPs seen in the Mayo Clinic Hospital Emergency Department (ED) between September 2008 and July 2012. The medical records of SPs were re-viewed and the documented LKTBW times of every physician assessing SPs in the ED were record-ed. When present, differences between these times were calculated in minutes. Results: Records on 809 SPs were reviewed. LKTBW data was documented for 725 SPs and of these, 254 (35%) had different LKTBW times (median = 30 minutes; range = 3-720 minutes). The differences were within 15 minutes in 31.1%; between 16–30 minutes in 35.0%; between 31–60 minutes in 16.2%; and more than 60 minutes in 17.7%. Among all SPs with LKTBW times docu-mented, these percentages were 10.9%, 12.3%, 5.7%, and 6.2% respectively. Conclusion: Incorrectly assessing when SPs were LKTBW could either deny acute stroke treatment to an eligible SP, or expose an SP to an increased risk of treatment related complications such as ICH. This study demonstrated that among physicians assessing suspected SPs in the ED, differences in estimated LKTBW times we’re seen in 35% of patients, and the differences were more than 30 minutes in 11.9% of patients overall. It is important that imaging techniques be developed which allow acute ischemic stroke treatment decisions to be made independently of estimated time since stroke onset.
Karger_ESC London_2013
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