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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 667 607 Acute stroke: emergency management, stroke units and complications Risk of Pneumonia Associated with Zero-Degree Head Positioning (Heads Down) In Acute Ischemic Stroke Patients Treated with Intravenous tPA A.L. Brooks1, M.J. Lyerly2, K.A. Sands3, M. Cronin4, D. James5, R. Moore6, R.B. Shahripour7, A.V. Alexandrov8, A.W. Alexandrov9 UAB Comprehensive Stroke Center, Birmingham, USA1, UAB Comprehensive Stroke Center, Birmingham, USA2, UAB Comprehensive Stroke Center, Birmingham, USA3, UAB Comprehensive Stroke Center, Birmingham, USA4, UAB Comprehensive Stroke Center, Birmingham, USA5, UAB School of Nursing, Birmingham, USA6, UAB Comprehensive Stroke Center, Birmingham, USA7, UAB Comprehensive Stroke Center, Birmingham, USA8, UAB Comprehensive Stroke Center, Bir-mingham, USA9 Background: Heads down positioning has been advocated as a method to increase blood flow in acute patients with large vessel occlusions. We sought to determine the risk of pneumonia in acute ischemic stroke patients treated with thrombolytic therapy. Methods: Consecutive IV-tPA treated patients were routinely positioned heads down for the first 24 hours as institutional standard of care. Serial breath sounds, SpO2, chest x-rays, temperatures, and WBCs were collected in addition to sputum cultures, dysphagia/diet, co-morbid CHF, airway man-agement, timing of heads down in relation to pulmonary symptom evolution, and mention of “pneu-monia” in medical records. Pneumonia cases were adjudicated by stroke, critical care, pulmonology, and emergency medicine experts to establish consensus on 1) if the diagnosis of pneumonia met evi-dence- based criteria, and 2) causal association with heads down. Results: Of 333 IV-tPA patients, 24 (7%) had mention of “pneumonia” in the medical record: 6 failed to meet evidence-based diagnostic criteria for pneumonia, and 3 had antecedent (i.e. aspi-ration en route to hospital) causal events. A clear causal association was established in one case (0.3%), and possible association between heads down and pneumonia in 14 cases (4.2%). Collec-tively, these 15 adjudicated cases had similar median admission NIHSS scores to non-pneumonia cases (10 vs. 9; p=ns), but were older (74+15 vs. 64+17 years; mean difference 9.89, 95% CI=1.2- 18.6; p=0.026). Pneumonia cases had longer hospitalizations (14.5+12 vs. 6.6+9 days; mean differ-ence 7.97, 95% CI=1.1-14.8; p=0.026) and higher median discharge mRS (4 vs. 3; p=0.003). Conclusion: Heads down is associated with a small risk of pneumonia in IV-tPA treated patients. Non-use of heads down due to concerns for subsequent pneumonia may be unjustified. Studies of the benefit of heads down should adhere to an evidence-based definition of pneumonia, with capture of potential contributing and confounding factors. 608 Acute stroke: emergency management, stroke units and complications Clinical outcomes and 2 year survival following PEG insertion after acute stroke – an observa-tional study. E. Mallouppa1, H. Leeman2, G. Pratt3, P. Callan4 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM1, Rother-ham NHS Foundation Trust, Rotherham, UNITED KINGDOM2, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM3, Hull and East Yorkshire NHS Trust, Hull, UNITED KINGDOM4 Background: The incidence of dysphagia following acute stroke is up to 40%, and associated with increased mortality. Trial data regarding the optimal timing for PEG insertion remains inconclusive. Data on survival outcomes following PEG insertion is also limited. Method: A retrospective analysis of 2 year survival rates of the last 30 consecutive patients to undergo PEG insertion following acute stroke on our unit, using Kaplan-Meier survival curves. Results: 19 case notes were analysed (1 ex-cluded, 10 unable to trace). Mean age was 78 (61-89) and 7 were male patients. In-hospital mortality was 32% (6/19) and a further 47% (9/19) of patients required nursing home care. Younger patients (age <80) had a better survival at two years, 7/11 (63.6%), median survival ≥2 years, compared with 1/8 (12.5%), median survival 3.2 months in the older group (log-rank p-value: 0.011). There was no statistically significant difference in 2 year survival between the sexes. Survival rates in patients with early (≤28 days from stroke onset) PEG insertion appear to be worse, with 2/8 (25%), medi-an survival 3.2 months versus 7/11 (64%), median survival 21.1 months in the late group (log-rank p-value: 0.163). Conclusions: Our study showed that advancing age and early PEG insertion are as-sociated with a poor prognosis. Delayed PEG insertion showed a trend towards improved survival. This may be due to a selection effect, reflecting the high early mortality associated with acute stroke. This data supports findings from previous studies, which fail to show an advantage of early PEG feeding.


Karger_ESC London_2013
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