22. European Stroke Conference 656 Acute stroke: clinical patterns and practice PARAMEDIC GLOBAL IMPRESSION OF CHANGE FOR STROKE PATIENTS DURING TRANSPORT N. Sanossian1, M. Kim-Tenser2, S. Starkman3, M. Eckstein4, S. Stratton5, F.D. Pratt6, S. Hamilton7, J.L. Saver8 FAST-MAG Investigators and Coordinators University of Southern California, Los Angeles, USA1, University of Southern California, Los Angeles, USA2, UCLA Stroke Center, Los Angeles, USA3, University of Southern California, Los Angeles, USA4, University of California Los Angeles, Los Angeles, USA5, Los Angeles County Fire Department, Los Angeles, USA6, Stanford University, Palo Alto, USA7, UCLA Stroke Center, Los Angeles, USA8 Background: Information provided by paramedic and Emergency Medical Services (EMS) person-nel on the clinical course of stroke patients during hospital transport is not routinely solicited but may be relevant to stroke care. We describe the use of a simple scale completed by paramedics upon arrival to the emergency department (ED). Methods: Consecutive cases were enrolled in the Field Administration of Stroke Therapy-Mag-nesium (FAST-MAG) clinical trial of neuroprotective magnesium vs. placebo for stroke patients presenting <2 hours from symptom onset. Paramedics transported study patients to their usual care hospital and upon arrival were asked to rate the degree of change in patient neurological status from the start time of study drug infusion (most often prior to transport) to ED arrival, using a paramed-ic global impression of change (PCIG) scale. The PGIC is a 5 point Likert scale with the following values: 1-much improved, 2-mildly improved, 3-unchanged, 4-mildly worsened, 5-much worsened. Results: 1265 consecutive subjects were enrolled from January 2005 to March 2011 mean age 70 (SD14), 43% women, 79% white race, 23% Hispanic ethnicity, 72% cerebral ischemia, 24% intrace-rebral hemorrhage and 4% mimic. Subjects were initially assessed by paramedics a median (IQR) of 18 (11, 31) minutes after onset and reached the ED 33 (28, 39) minutes after paramedic arrival. Re-sponse rate on the PGIC was 97.8%. Frequencies of PGIC values were: 1-8%, 2-23%, 3-62%, 4-4%, 5-1%. Improvement (PGIC 1 or 2) was more common than worsening (PGIC 4 or 5), 31% vs 5%. Worsening on the PGIC was associated with higher prehospital systolic BP (168 vs 160, p=0.023) and ICH (53% vs 21%, p<0.0001). Conclusions: Paramedic global impression of scale can be elicited with a high degree of compliance. More than one-third of patients have changes in the neurologic status in the field, with improvement more common than worsening; worsening is associated with elevated blood pressure and ICH stroke subtype. 694 © 2013 S. Karger AG, Basel Scientific Programme 657 Acute stroke: clinical patterns and practice NIHSS in Posterior circulation Stroke - Is it fit for purpose? P. Boovalingam1, A. Vanwyk2, S. Seetharaman3, S. Khan4, E. Flossmann5, R. Nagarajan6, L. Bar-ber7, F. Jeddy8, G. Pope9 Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM1, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM2, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM3, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM4, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM5, University Hospitals of Leicester NHS Trust, Leicester, UNITED KINGDOM6, Royal Berkshire NHS Foun-dation Trust, Reading, UNITED KINGDOM7, Royal Berkshire NHS Foundation Trust, Reading, UNITED KINGDOM8, Oxford University Hospitals NHS Trust, Oxford, UNITED KINGDOM9 Background The National Institutes of Health Stroke Scale (NIHSS) is commonly used as a standard tool to as-sess the severity of a patient’s neurological deficit in the acute stroke unit in United Kingdom. This scale demonstrated excellent reliability and validity and has been used in most stroke research trials to estimate neurological and functional outcome. However, this scale is mainly prejudiced towards signs caused by anterior-circulation strokes and this not always applies to posterior circulation strokes. Currently it is not clear whether NIHSS score can also envisage significant complications (SC) (both medical and neurological) in patients with posterior circulation strokes. Therefore the aim of this case series was to see whether the National Institutes of Health Stroke Scale (NIHSS) score was related with in hospital significant complications (SC) in patients with posterior circula-tion strokes. Methods We collected the data of posterior circulation stroke patients from our hospital stroke registry (Royal Berkshire NHS Foundation Trust, a large teaching hospital in UK) for a period of six months from August 2011 to March 2012.Signicant Complications (SC) included deterioration in neurological status (NIHSS deterioration by 4 points or more during in patient admission) and all other complica-tions based on patients case notes documentation. Results Fifteen patients (24.5%) with posterior circulation experienced SC. On comparison with anterior circulation stroke patients, posterior circulation infarction patients (n = 61) with SC had low base-line NIHSS score (2.1 versus 11.3, P = 0.004) . However in anterior circulation stroke patients with logistic regression, an NIHSS score >5(odds ratio: 6.2; 95% C.I: 2.64–12.25; p = 0.004) was associ-ated with SC. Conclusion In ischemic stroke patients, an increased baseline NIHSS score was associated with an increased risk of SC. This association more reliable only in anterior circulation and not necessarily in posterior circulation. This demands the need for new stroke scale for posterior circulation and importance of these findings call for further assessment in prospective randomised control trials.
Karger_ESC London_2013
To see the actual publication please follow the link above