22. European Stroke Conference 638 Acute stroke: emergency management, stroke units and complications Is Mobile Intensive Care Unit worthwhile for suspected acute stroke? F. Boutot1, K. Milojevic2, S. Parisse3, S. Lorilloux4, A. Sar5, L. Dalle6, M. Koukabi7, Y Lambert8 SAMU 78, Versailles Hospital, Le Chesnay, FRANCE1, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE2, SAMU 78, Versailles Hospital, LeChesnay, FRANCE3, SAMU 78, Ver-sailles Hospital, Le Chesnay, FRANCE4, Emergency Department, Versailles Hospital, Le Chesnay, FRANCE5, Emergency Department, Versailles Hospital, Le Chesnay, FRANCE6, Emergency De-partment, Versailles Hospital, Le Chesnay, FRANCE7, SAMU 78, Versailles Hospital, Le Chesnay, FRANCE8 Background: In France, call to medical dispatching center (15, equivalent to 112, 911) for suspected acute stroke (SAS) reduces time to treatment. French studies have estimated that when mobile inten-sive care unit (MICU) is activated (vs standard emergency ambulance), pre-hospital time increase (+20 to +40 min) is counterweighted by emergency department (ED) by-pass and direct access to imaging (-20 to -40 min). The aim of this study was to estimate the advantage and quality of MICU management for SAS. Methods: This prospective survey included 778 MICU patients with SAS (2004 to 2012). MICU files and hospital reports were reviewed to collect or calculate: NIHSS scoring rate, correlation and agreement between MICU and Stroke Unit NIHSS (differences > 3 points considered as disagree-ments), stroke unit orientation, ED by-pass for immediate imaging, thrombolysis rate, intubation rate, exclusion from thrombolytic alert procedure. Results: Out of 778 enrolled patients were 381 ischemic stroke (49%), 184 hemorrhagic strokes (24%) and 213 stroke mimics (27%). Table I shows main results for 3 groups. MICU NIHSS scoring rate was 82% for all SAS, significantly higher for ischemic stroke. NIHSS correlation and agree-ment between MICU and Stroke Unit (calculated on 538 comparisons) were 97 and 95% (no differ-ences between groups). Intubation rate was 12% among all patients and 76% among GCS < 8. In stroke units, 111 patients received thrombolysis: 29% among ischemic stroke. MICU considered 110 patients were to be excluded from thrombolysis (stroke ruled out 77%, extreme severity 18%). Conclusion: NIHSS performed by MICU physicians is strongly correlated to that of certified neu-rologists. MICU allows accurate patient triage before stroke unit admission by excluding important proportion of differential diagnosis and non-indications for thrombolysis. Selection of patients justi-fies priority access to imaging by-passing ED, and leads to high prevalence of thrombolysis. Table I: MICU management of SAS described with activity indicators Isch-emic Hemor-rhagic Mim-ics NIHSS scoring rate by MICU 95% 79% 63% Intubation rate by MICU 7% 41% 4% Stroke Unit orientation rate 98% 83% 60% Immediate imaging (ED by-pass) 684 © 2013 S. Karger AG, Basel Scientific Programme rate 90% 75% 45% Exclusion from thrombolysis alert 2% 10% 40% 639 Acute stroke: emergency management, stroke units and complications Evaluation of the validity of a quick predefined questionnaire to predict coagulopathy before i.v. rtPA use. X. Ustrell1, A. Pellisé2, M.R. Aguinaco3, M. A. Mañé4, J. Casanova5, J. Viñas6, R. Mares7 Stroke Unit. Neurology depertament. Hospital Universitari Joan XXIII. Institut Investigació Sanitaria Pere Virgili (IISPV)., Tarragona, SPAIN1, Stroke Unit. Neurology depertament. Hos-pital Universitari Joan XXIII. IISPV, Tarragona, SPAIN2, Hematology department. Hospital Uni-versitari Joan XXIII, Tarragona, SPAIN3, Neurology department. Hospital Universitari Joan XXIII, Tarragona, SPAIN4, Neurology department. Hospital Universitari Joan XXIII, Tarragona, SPAIN5, Neurology department. Hospital Universitari Joan XXIII, Tarragona, SPAIN6, Neurology depart-ment. Hospital Universitari Joan XXIII, Tarragona, SPAIN7 Background Successful and save use of intravenous thrombolytic therapy (rtPA) for acute ischemic stroke re-quires a rapid assesment for any contraindication. Normal prothrombin time (PT) and partial throm-boplastin time (PTT) are required before rtPA use. Delays in treatment minimize the possibility of recanalization and increase the risk of hemorrhagic transformation. Some clinicians, if patients are not at risk of elevated PT/PTT, may give rtPA before results are available. There’s no consensus on risk/benefit for waiting or not for laboratory coagulation test results. The objective of the study is to asses the sensitivity and negative predictive value of five predeter-mined questions to predict an underlying coagulopathy and consequently contraindication for i.v. rtPA use. Methods We analysed 149 consecutive acute stroke code patients from our Emergency Stroke Code database during a 6-month period attended in the Emergency Room evaluating predetermined risk factors as-sociated with elevated PT/PTT. We predefined five questions to determine the hemorrhagic risk and we compared them blindly with the haemostatic laboratory results. We evaluated the presence/absence of anticoagulant therapy, al-cohol abuse and/or hepatopathy, chronic renal failure, haematological diseases and history of bleed-ing. Results We detected 22 patients with risk by history of underling coagulopathy, 8 of them with altered PT/ PTT. None of the patients without risk of underlying coagulopathy had elevated PT/PTT. Elevated PT/PTT could be predicted with a quick questionnaire with 100% sensibility, 90% specific-ity and with a 100% negative predictive value. Conclusions There’s evidence that in the absence of the above predictable risk factors, the likelihood that the PT/ PTT is pathologically elevated is small and i.v. rtPA administration could be considered. These results could be applied to rtPA candidates with a quick predefined questionnaire and reduce potential delays thus ultimately improving outcomes.
Karger_ESC London_2013
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