London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 681 631 Acute stroke: emergency management, stroke units and complications Influence of accumulated experience of a stroke unit on stroke prognosis. J.C. Portilla Cuenca1, J.M. Ramirez2, F. Lopez Espuela3, R. Romero Sevilla4, J.A. Fermin Marre-ro5, I. Bragado6, M. Gomez Gutierrez7, P.E. Jimenez8, A. Serrano Cabrera9, M. Calle Escobar10, A. Roa Montero11, G. Gamez Leyva12, A. Falcon Garcia13, M. Caballero Muñoz14, I. Casado Naranajo15 Hospital San Pedro de Alcantara. Stroke Unit, Caceres, SPAIN1, Hospital Infanta Cristina, Bada-joz, SPAIN2, Hospital San Pedro de Alcantara, Caceres, SPAIN3, Hospital San Pedro de Alcantara, caceres, SPAIN4, Hospital San Pedro de Alcantara, caceres, SPAIN5, Hospital San Pedro de Alcan-tara, Caceres, SPAIN6, Hospital San Pedro de Alcantara, caceres, SPAIN7, Hospital San Pedro de Al-cantara, caceres, SPAIN8, Hospital San Pedro de Alcantara, caceres, SPAIN9,Hospital San Pedro de Alcantara, caceres, SPAIN10, Hospital San Pedro de Alcantara, caceres, SPAIN11, Hospital San Pedro de Alcantara, caceres, SPAIN12, Hospital San Pedro de Alcantara, Caceres, SPAIN13, Hospital San Pedro de Alcantara, caceres, SPAIN14, Hospital San Pedro de Alcantara, Caceres, SPAIN15 Background: Specialized stroke unit care improves outcome among patients with stroke, but little is known about experience of a stroke unit and stroke prognosis. We analyze the outcome of our pa-tients in function of cumulative experience in a stroke unit. Methods: A retrospective cohort study of patients admitted in our stroke unit. We differentiate two groups according to the year of admission: group A (July 2007-December 2009) and group B (Janu-ary 2010-December 2011), analyzing early prognosis based on the score in the National Institute of Health stroke scale and mortality at discharge and medium-term prognosis in terms of mortality and functional status according to the modified Rankin scale at three months. Results: A total 1070 patients were included. There were no difference between groups neither in early favorable outcome (68,3% vs 63,9), nor in both inhospital mortality(5,1% vs 6,6%) and 90- day mortality (12,8% vs 13,1%). The proportion of independents at 90 days was greater in group B (56,3% vs 65,5%, p 0,03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy the association between independence and admission period was maintened. Conclusion: The probability of functional independence in our patients increased with the accumu-lated experience in our stroke unit with no differences in mortality. 632 Acute stroke: emergency management, stroke units and complications The patient and carer experience of centralised acute stroke services B.J. Moynihan1, S. Paul2, H.S. Markus3 St. George’s Hospital, London, UNITED KINGDOM1, St. George’s Hospital, London, UNITED KINGDOM2, St. George’s University of London, London, UNITED KINGDOM3 Background and Purpose- Intravenous thrombolysis with alteplase is the only currently licensed treatment in acute ischaemic stroke. Reorganisation of stroke services may improve access to thrombolysis. In 2010 Healthcare for London launched a new model based on hyperacute stroke unit (HASU) care with intensive staffing for the first 72 hours, followed by repatriation for ongoing stroke unit care in a local district hospital stroke unit. The patient and carer experience of this model of care has not been previously reported. Methods- Patient and carer experiences of the new model were assessed via questionnaires based on the Picker Questionnaire. These were sent shortly after discharge from the HASU. Separate ques-tionnaires were used for patients discharged directly home from the HASU, those repatriated to local stroke units and carers of patients admitted to the HASU. Results- We received 213 responses from 429 patients discharged directly home, 235 responses from 483 carer questionnaires and interviewed 100 patients following repatriation. 89% of patients and 86% of carers were satisfied with admission to the HASU. 22% of patients and 43% of carers were worried about moving wards or hospitals. 69% of repatriated patients thought moving did not affect recovery with 10% reporting a positive and 6% a negative effect. Carers reported similar ef-fects but a higher (15%) negative impact on recovery from repatriation. Self-reported stroke severity was higher in patients requiring repatriation (27% severe) than those discharged home (4% severe). Thrombolysis rates increased from 6 to 9% of all HASU admissions, with a 2.5-fold increase in ad-missions. The number of patients thrombolysed increased threefold. Mean HASU length of stay was 3 days. Conclusion- Patients and carers report high levels of satisfaction with the HASU model of stroke care. Anxiety about moving is common but moving hospitals does not appear to affect self-reported stroke recovery.
Karger_ESC London_2013
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