22. European Stroke Conference 621 Acute stroke: emergency management, stroke units and complications Reduction of door – to – needle time in Stroke unit Kladno M. Sramek1, T. Ruzickova2 Charles University, 2nd Faculty of Medicine, Prague and Stroke Unit, Regional Hospital Klad-no,, Kladno, CZECH REPUBLIC1, Stroke Unit, Regional Hospital Kladno, Kladno, CZECH RE-PUBLIC2 Background: Intravenous trombolysis (IVT) is more effective the shorter the time from admission to the treatment – interval known as door to needle time (DNT). The recommended DNT does not exceed 60min, efforts for further reduction of DNT to 40min exist. The goal of our study is to de-termine DNT in our stroke unit and its change after the introduction of new organizational arrange-ments in May 2012 Methods: Firstly, an analysis of IVT-treated patients (group A, 51 pts) was made in order to describe local situation. No statistically significant difference was found between patients treated at various times of the day (morning, afternoon, night), on various days of week (weekdays, weekends) nor by various physicians on duty. Four time intervals were analysed: 1/ time from onset of stroke to emer-gency call, 2/ time from call to arrival at the door of hospital, 3/ time from arrival to CT scan and 4/ time from CT to IVT initiation. Secondly, four steps were made in May 2012 to shorten the total time from onset to IVT. I – educa-tion of the public by popular science articles in local press, II – close cooperation with emergency staff, advance notice of IVT candidates by phone, III – reservation of the CT after the notice, IV – initiation of IVT without lab results in selected patients. Finally, an analysis of IVT patients treated since May 2012 (group B, 33 pts) was made following the same criteria as the first analysis. Results: Time intervals in the groups A/B were: 1/ 23,5 min / 31,5 min, 2/ 37,5 min / 43,5 min, 3/ 19 min / 20 min, 4/ 41 min / 21,5 min. Median DNT in group A was 60 min, in group B 50 min. Odds ratio for treatement initiation in 60 min was 2,37 comparing groups B to A, difference was not sta-tistically significant (OR (95% CI)=2,37 (0,925, 6,11). Conclusion: Organizational arrangemets led to shorter DNT. Most effective in our stroke unit is ini-tiation of IVT without waiting for lab results in selected pacients. 676 © 2013 S. Karger AG, Basel Scientific Programme 622 Acute stroke: emergency management, stroke units and complications Acute Stroke Thrombolysis - a Welsh centre’s perspective Q.T.H. Anjum1, H.G.M Shetty2, A Reed3, T.A.T Hughes4, P.E. Smith5, T. Pickersgill6, S Ahmad7, S White8, R Corkill9, M Wardle10, C Krishna11, A Osman12, K Smith13 on behalf of stroke thrombolysis team at University Hospital of Wales (UHW) Department of Stroke Medicine, University Hospital of Wales (UHW), Cardiff, United King-dom, swansea, UNITED KINGDOM1, Department of Stroke Medicine, University Hospital of Wales (UHW), Cardiff, UK, Cardiff, UNITED KINGDOM2, Department of Stroke Medicine, Uni-versity Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM3, Department of Neurosciences, University Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM4, Department of Neurosciences, University Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM5, Department of Neurosciences, University Hospital of Wales (UHW), Cardiff, UK, car-diff, UNITED KINGDOM6, Department of Stroke Medicine, University Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM7, Department of Stroke Medicine, University Hospital of Llandough (UHL), Cardiff, UK, cardiff, UNITED KINGDOM8, Department of Neurosciences, University Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM9,Department of Neurosciences, University Hospital of Wales (UHW), Cardiff, UK, cardiff, UNITED KINGDOM10, Department of Acute Medicine & Pharmacology, University Hospital of Llandough (UHL), Cardiff, UK, cardiff, UNITED KINGDOM11, Department of Acute Medicine, University Hospital of Llan-dough (UHL), Cardiff, UK, cardiff, UNITED KINGDOM12, Welsh Ambulance Services, Cardiff, Cardiff, UNITED KINGDOM13 Background: Thrombolysis with intravenous alteplase within 4.5 hours improves outcomes in acute ischaemic stroke (AIS) patients, and especially if administered earlier. Since the inception of the thrombolysis service, we have been striving to reduce the door-to-needle (DTN) time. Methods: This study forms part of a planned service evaluation. We scrutinised the stroke data-base and medical records for all patients thrombolysed between July 2010 and November 2012 (29 months). We defined outcomes measures as time delays, significant haemorrhages, short-term mor-tality and functional outcomes. Results: 146 patients were thrombolysed (median range age 75 yrs 28-100; 54% male) (throm-bolysis rate 12% vs. 8% UK average). 95% patients were thrombolysed for anterior circulation strokes (NIHSS median (range) 14 (2-27). Median (IQR) delay from 999 calls to A&E arrival was 75 mins (57-106). Door to CT median (IQR) delay was 34 mins (17-68). Median (IQR) CT to needle time was 46 mins (21-79). Median (IQR) DTN time 80 mins (21-72). Median thrombolysis to Acute Stroke Unit (ASU) admission time was 75 minutes. 2% (3/146) patients had symptomatic intra-cerebral haemorrhages (all of whom died). All-cause mortality at 3 months was 12% (18/146). Pre-thrombolysis 64% (93/146) of patients had a Modified Rankin Score (MRS) of 5 and 27% (40/146) had MRS of 4. 3 months later only 5% (7/146) patients had MRS of 5 and 8% (12/146) had MRS of 4 14% had MRS 3, 20% had MRS 2, 27% had MRS 1 and 13% had MRS 0 at 3 months. 71% patients were discharged to their usual residence (readmission rate 2.5%). Conclusions: Our analysis identifies significant scope to reduce onset-to-treatment time. We have implemented measures to reduce delays at all levels of the pathway. It is reassuring that the inci-dence of serious intra-cerebral haemorrhage was low and 60% of the patients had very good func-tional outcomes (MRS 0-2).
Karger_ESC London_2013
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