22. European Stroke Conference 585 Acute stroke: emergency management, stroke units and complications The Stroke Eastern Saxony Network: An evaluation of Telestroke thrombolysis over 5 years C. Zerna1, V. Puetz2, C. Wojciechowski3, I. Dzialowski4, J. Kepplinger5, K. Barlinn6, L.P. Pallesen7, G. Gahn8, H. Reichmann9, R. von Kummer10, U. Bodechtel11 Department of Neurology, Technical University Dresden, Dresden, GERMANY1, Department of Neurology, Technical University Dresden, Dresden, GERMANY2, Department of Neurology, Tech-nical University Dresden, Dresden, GERMANY3, Department of Neurology, Technical University Dresden, Dresden, GERMANY4, Department of Neurology, Technical University Dresden, Dresden, GERMANY5, Department of Neurology, Technical University Dresden, Dresden, GERMANY6, De-partment of Neurology, Technical University Dresden, Dresden, GERMANY7, Department of Neu-rology, City Hospital of Karlsruhe, Karlsruhe, GERMANY8, Department of Neurology, Technical University Dresden, Dresden, GERMANY9,Department of Neuroradiology, Technical University Dresden, Dresden, GERMANY10, Department of Neurology, Technical University Dresden, Dres-den, 654 © 2013 S. Karger AG, Basel Scientific Programme GERMANY11 Background: The Stroke East Saxony Network (SOS-NET) provides telemedical consultations for patients with acute ischemic stroke. Stroke neurologists recommend intravenous (IV) thromboly-sis based on patient history, video examination and standardized evaluation of cerebral CT scans. We sought to assess the clinical course and functional outcome of patients who were thrombolyzed based on telemedical assessment. Methods: We analyzed consecutive SOS-NET patients from 7 representative community hospitals who were treated with IV thrombolyis from 07/07 to 06/12. Clinical data were prospectively collect-ed with quality assurance forms. Missing data were retrospectively derived from in-patient records. Primary endpoint was symptomatic intracranial hemorrhage (sICH) defined by ECASS-2 criteria. Secondary endpoints were favourable outcome (mRS scores of 0-2) at discharge and in-hospital mortality. Results: Among 1363 teleconsultations stroke neurologists recommended IV thrombolysis in 309 patients (22.7%) and 293 patients (21.5%) were finally thrombolyzed. Reasons for community hos-pital to withhold IV thrombolysis were spontaneous improvement of symptoms (n=2), refusal of consent (n=3) or thrombolysis contraindications unknown at the time of teleconsultation (n=11). Median age of the 293 thrombolyzed patients was 76 (interquartile range 11) years, baseline NIHSS score 12 (10) and onset-to-needle time 145 (84) minutes. Thirteen patients (4.4%) suffered sICH and 54 patients (18.4%) died during the hospital course. Of 251 patients with mRS scores available at discharge, 91 patients (36.3%) had a favourable outcome. Conclusion: Telemedical assessments resulted in a greater than 20% IV thrombolysis rate of all tele-consultations in our telestroke network. There was a low rate of thrombolysis-related sICH. We will analyze factors related to sICH and poor functional outcome in further studies. 586 Acute stroke: emergency management, stroke units and complications Impact of thrombolysis in a District General Hospital: How many patients are actually as-sessed for one patient to be treated with rt-PA. J. W. McKee1, S Todd2, J McElroy3, J Corrigan4, M McCarron5, A Elleithi6, S Philips7, D Dunne8 Altnagelvin Hospital Care of Elderly, Londonderry, UNITED KINGDOM1, Altnagelvin Hospi-tal Care of Elderly, Londonderry, UNITED KINGDOM2, Altnagelvin Hospital Care of the Elderly, Londonderry, UNITED KINGDOM3, Altnagelvin Hospital Care of the Elderly, Londonderry, UNIT-ED KINGDOM4, Altnagelvin Neurology, Londonderry, UNITED KINGDOM5, Altnagelvin Care of the Elderly, Londonderry, UNITED KINGDOM6, Altnagelvin Care of Elderly, Londonderry, UNIT-ED KINGDOM7, Altnagelvin Care of the Elderly, Londonderry, UNITED KINGDOM8 BACKGROUND: Stroke is the 3rd most common cause of disability in the UK. Alteplase (rt- PA) is the single proven treatment for acute ischaemic stroke. It improves functional outcome and reduces neurological impairment if given within 4.5 hrs of onset (ECASS 3, NINDS trial). Very little evidence has been published on the number of patients who require urgent assessment before one patient is treated. Most studies are based on numbers needed to treat for successful outcome or numbers needed to harm. However, Slaght et al (2010) carried out a similiar study, difference was the length of their study and treatment time was < 3 hrs of onset. Thrombolysis was set up in the Western Trust in 2009 as a 9-5 service moving to a 24/7 service in August 2011. The Western Trust is divided into 2 sectors Northern and Southern serving a population of approx 300,000 people. It is the Northern Sector (Altnagelvin) that this study is focused. Altnagelvin treats approximately 185 strokes per year. Thrombolysis is delivered by a dedicated team of Geriatricians, Neurologists, Reg-istrars and Specialist stroke nurse. Team is contacted via an emergency bleep system. Purpose was to identify numbers of patients urgently assessed for rt-PA and those who actually received it. The overall aim was to identify how the numbers assessed impacted on our weekly workload. METH-OD: We retrospectively kept a log of all urgent referrals, from 13/08/12 - 13/01/13. Data recorded included, date, time, patient details, was rt-PA administered and reasons for not. We used telephone logs to compare findings. RESULTS: 102 referrals, 13 recieved rt-PA, 19 outside 4.5 hrs, 26 TIAs, 7 excluded by CT findings, 3 baseline Rankin > 4, 34 mimics. CONCLUSION: Even though this has been a small prospective log, the numbers are quite convincing. Numbers who recieved rt-PA >10% in keeping with national targets. 7.8 patients assessed for one treated. 5 patients assessed per week. The study will continue over a longer period of time and compared to original findings. It is anticipated that the number of mimics will also be investigated.
Karger_ESC London_2013
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