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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 661 597 Acute stroke: emergency management, stroke units and complications Is there really no need for a ‘routine’ Chest Radiograph on presentation following stroke? N.L. Thompson1, J. Azam2, O Mahon3, J.A. Harbison4 Trinity College Dublin, Dublin, IRELAND1, St James’s Hospital, Dublin, IRELAND2, St James’s Hospital, Dublin, IRELAND3, Trinity College Dublin, Dublin, IRELAND4 Introduction: Routine admission Chest radiography for Stroke/TIA is not recommended by ESO or AHA guidelines but can be requested ‘where indicated’. There is a high prevalence of cardiopulmo-nary disease in stroke patients which may not be apparent from presentation history or examination. We performed a study to determine the utility of Chest x-rays performed at presentation of stroke patients to the Emergency department (ED). Methods. Results for 75 consecutive patients (27 TIA, 48 stroke) admitted acutely to the ED were reviewed by an independent physician to determine if Chest Radiographs were performed, if they showed a clinically significant finding, if this corresponded to examination findings and if the sub-ject suffered a cardiopulmonary complication in the 7 days post admission for which an available baseline x-ray would have proved valuable. Modified Rankin score was determined for each patient at admission and patients were classified as being either Independent (MRS 0-2) or Dependent MRS (3-5). Results. Of the 75 patients 31 were dependent and 44 independent at presentation. 45 (60%) had a chest ra-diograph at admission, neither group were more likely to undergo a radiograph. 20 patients radio-graphs (27%) were reported as having a significant abnormality an admission but this was reflected on chest examination in only 7 cases (35%). Abnormalities were significantly more likely to be found in dependent patients’ x-rays 13/19 vs. 7/26 (p=0.01 Chi Square). 8 of the dependent patients (26%) developed cardiopulmonary complications requiring further in-vestigation by day 7, none of the independent patients did (p=0.0004 Fishers Exact). Conclusions. Dependent stroke patients have a high prevalence of clinically undetected but relevant abnormalities on admission radiographs and are at high risk of developing chest complications in the days follow-ing stroke. Clinicians should have a low threshold for requesting admission Chest x-ray for depen-dent stroke patients. 598 Acute stroke: emergency management, stroke units and complications Improving Door to Needle Time Out of Hours in a London Hyper Acute Stroke Unit A. Khan1, S.H. Ugharadar2, S. Hussain3, P. Gompertz4, S.A. Haddadi5, R. Yadava6, K. Saastamoin-en7, A. Andrews8, H. Sayed9, A. Jackson10, M. Khan11 Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM1, Royal Lon-don Hospital, Barts Health NHS Trust, London, UNITED KINGDOM2, Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM3, Royal London Hospital, Barts Health NHSTrust, London, UNITED KINGDOM4, Royal London Hospital, Barts Health NHS Trust, Lon-don, UNITED KINGDOM5, Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM6, Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM7, Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM8, Newham Univer-sity Hospital, Barts Health NHS Trust, London, UNITED KINGDOM9,Newham University Hospi-tal, Barts Health NHS Trust, London, UNITED KINGDOM10, Royal London Hospital, Barts Health NHS Trust, London, UNITED KINGDOM11 Introduction: The benefits of Stroke thrombolysis are time dependent. Reducing door to needle times (DNTs) is vital, especially out of hours where DNTs are longer. We used an audit process to generate a new protocol to reduce the median DNT out-of-hours (OH). We also aimed to reduce the difference in the times between working hours (WH) and OH, thereby providing a similar thrombol-ysis service for patients throughout the day. Methods: We compared key stages in the thrombolysis pathway between WH and OH from June to November 2011 and August 2012 to January 2013. The time intervals during each stage were col-lected on a case by case basis. Common causes of delays were identified from weekly thrombolysis audit meetings. New protocol was suggested including the omission of CT angiograms as part of routine tests and the use of point of care INR check to help minimise delays. The effects of the new protocol were analysed as part of a re-audit. Results: Median DNT OH was reduced by 28.8% from 59 minutes to 42 minutes (p=0.000414). Me-dian time from CT scan to thrombolysis time out-of-hours was reduced by 60.5% from 38 minutes to 15 minutes (p=0.0003). The discrepancy between DNTs during WH and OH was also reduced (p=0.182). The difference between the WH and OH median DNTs in 2011 was 15 minutes. Fol-lowing the new protocol the difference was reduced by 53.3% to 7 minutes. The difference from CT scan done to thrombolysis between WH and OH was 12 minutes in 2011. This was reduced by 58.3% to 5 minutes in 2013. Lastly, 75% of patients were thrombolysed within 45 minutes of arriv-al, compared to 61% in 2011. Conclusions: Omitting routine CT angiograms together with other measures to streamline the throm-bolysis pathway help to reduce median DNT OH. A specified protocol also helps provide a more ho-mogenous service all throughout the day. DNTs continue to be better during WH; however the gap between the services has reduced.


Karger_ESC London_2013
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