London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 655 587 Acute stroke: emergency management, stroke units and complications How fast is FAST?: A London HASU Experience. S. Andole1, K. JAHAN2 BARKING HAVERING AND REDBRIDGE HOSPITALS NHS TRUST, ROMFORD, UNIT-ED KINGDOM1, BARKING HAVERING AND REDBRIDGE HOSPITALS NHS TRUST, ROM-FORD, UNITED KINGDOM2 Background:Whilst it is very well known that screening tools such as FAST is not completely re-liable but it is important to recognise that negative predictive value for these tools.This was also a pilot study for a proposed wider prospective study within London HASU’s to see similar trends. Materials and Methods;We randomly collected data from patients admitted to Stroke Unit at Queens Hospital, single hyper acute stroke centre and retrospective randomised data was analysed between Feb 2012 and October 2012.Final outcome of the patients in both these groups were independently checked on electronic discharge summaries and radiological scans. For this purpose we also graded the severity of stroke as per Rankin score and evidence of stroke on CT/MRI scanning. The mean time from symptom onset to arrival for FAST positive patients was 79.48 minutes (37 patients) and for FAST negative patients (16) it was 136.81 minutes. Both groups of patients have variable symp-toms and severity of strokes was also unpredictable.Results:1.The mean time from symptom onset to arrival for FAST positive patients was 79.48 minutes (37 patients) and for FAST negative patients (16) it was 136.81 minutes. Both groups of patients have variable symptoms and severity of strokes was also unpredictable.2. We also analysed the final outcome of patients in both these groups as re-corded on discharge summaries and found that FAST negative patients had predominantly disabling strokes as measured by Rankin and Radiology data.3. The final diagnosis of stroke in FAST negative patients was made by doctors.4. FAST negative patients were seen late after their arrival in hospi-tal. Conclusions:1. Screening tools have a limited role in diagnosis and cannot be completely relied upon to make the diagnosis of stroke 2. FAST negative patients with stroke are likely to be disad-vantaged at several stages during their journey till their eventual admission into stroke unit.3. It may be difficult to quantify the ‘effect of delays’ on poor outcome in this group but there is definitely negative relationship.4. Diagnosis of stroke in this group is often difficult and needs physician as-sessment for confirmation. 588 Acute stroke: emergency management, stroke units and complications Emergency Medicine physicians can safely and effectively deliver out of hours stroke throm-bolysis I. Logan1, H. Chandrashekar2, M. Lambert3, M. Johnston4, W. Morrison5, C. Donald6, M. Donald7, S. Thakore8, N. Nichol9, B. Klaassen10, A. Reddick11, R. Duncan12, B. Paterson13, A. Doney14, R. MacWalter15 Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM1, Ninewells Hospital and Medical School, Dundee, 2, Ninewells Hospital and Medical School, Dundee, UNITED KING-DOM3, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM4, Ninewells Hospi-tal and Medical School, Dundee, UNITED KINGDOM5, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM6, Ninewells Hospital and Medical School, Dundee, UKRAINA7, Ninewells Hospital and Medical School, Dundee, UGANDA8, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM9, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM10, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM11, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM12, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM13, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM14, Ninewells Hospital and Medical School, Dundee, UNITED KINGDOM15 Background Thrombolysis is a mainstay of acute management of ischaemic stroke, and relies on rapid assess-ment and treatment. Often overseen by Stroke physicians, the provision of a 24 hour service is diffi-cult in many UK hospitals. We present a novel method for delivering out of hours (OOH) thrombol-ysis. Methods Since March 2011, Emergency Medicine (EM) consultants in Ninewells Hospital have led the im-mediate assessment and management of acute stroke patients in the Emergency Department (ED). ED radiographers are trained to perform non-contrast CT, with support from the duty radiologist. Acute Stroke Unit (ASU) nurses are involved, with telephone advice available from Stroke physi-cians. All stroke cases admitted via the ED are discussed on a weekly basis. To compare this approach against the daytime service run by the ASU, we performed a retrospective survey of the Ninewells Stroke database, which records all acute admissions. Period 1 covers March to December 2011, and Period 2 covers January to December 2012. OOH is defined as 5pm to 9am Monday to Friday, all weekends and public holidays. Results Table 1 shows the mean age of patients is slightly higher during the day, but that door-to-needle-time is comparable, particularly in Period 2. All thrombolysis-related complications and deaths occur in the ASU, where patients remain un-til medically stable. Table 2 shows that overall mortality rates are similar. 2/7 patients in the OOH group had haemorrhage on follow-up CT, compared with 1/8 in the day group. One patient in the day group died prior to follow-up imaging. SITS-MOST data were comparable between the groups. Conclusion OOH thrombolysis can be safely and effectively delivered by EM consultants, once relevant train-ing, infrastructure and resources are provided. Continual development through formalised case re-view of patients admitted via the ED is essential, to ensure that appropriate decisions are made. This model could be adopted by other centres in the UK.
Karger_ESC London_2013
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