Abstracts Presented at the SMART STROKES 2019 Conference, 8–9 August 2019, Hunter Valley, NSW

Abstract

Abstracts Presented at the SMART STROKES 2019 Conference, 8–9 August 2019, Hunter Valley, NSWs Presented at the SMART STROKES 2019 Conference, 8–9 August 2019, Hunter Valley, NSW Concurrent Session 1 -Stream 1: ACUTE CARE Prehospital notification of suspected stroke patients to a dedicated stroke team improves access to reperfusion therapies Manju John, Chris Burrows, Brett Jones, Howard Wren, Betty Domazet and Christian Lueck Neurology Department, Canberra Health Services, Canberra, ACT, Australia; ACT Ambulance Service, Canberra, ACT, Australia; Emergency Department, Canberra Health Services, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia Background: A previous audit demonstrated that nurse-led triage of stroke calls from the emergency department (ED) improved time metrics for diagnostics and thrombolysis in our centre. Our local ambulance service recently introduced a screening tool to identify acute stroke patients and facilitate prehospital notification. This was introduced despite concern regarding possible inappropriate prenotification (e.g. stroke mimics and ineligible strokes). We sought to determine whether introduction of the tool was associated with improved metrics and whether there was inappropriate prenotification. Methods: Retrospective audit of the stroke unit registry from July 2017 to February 2019. Patients notified by the ambulance service as having a suspected acute stroke using the screening tool (CRESST) were identified. Time metrics for prenotified patients who received reperfusion therapies where compared to baseline local data, and inappropriate prenotification was determined from final diagnoses. Results: 799 patients were referred to the stroke service from the ED during the trial period. 82 patients had positive CRESST scores indicating possible stroke. Of these, 58 (70.73%) had a final diagnosis of stroke, of whom 40 (69.0%) had ischaemic stroke. Of these, 15 (37.5%) received reperfusion therapy. Compared to baseline data, prenotified patients received CT and thrombolysis, 2 and 15 minutes earlier, respectively. Prenotification resulted in a 32.5 minute time advantage compared to no stroke call and there was no increase in inappropriate prenotification. Discussion: While audited numbers are low, prenotification resulted in clear trend towards improved time metrics without an increase in inappropriate prenotification. Improving the thrombolysis rates and door to needle times – The Radiographer’s role Janeen Gibbs Royal North Shore Hospital, St Leonards, NSW, Australia Background: Thrombolysis and endovascular treatment for patients with ischaemic stroke is a time critical therapy. Radiographer engagement is key to early acquisition and interpretation of brain imaging and rapid treatment of the acute stroke patients. As part of an ongoing initiative to reduce the door-to-needle times, we implemented a ‘stroke team page’ that involved early notification of the radiographers for rapid imaging of patients screened for Hyperacute treatment. Methods: The ‘stroke team page’ was implemented in April 2016 to improve the thrombolysis service. Stroke imaging pathway was improved by implementing changes in processes that ensured the stroke patient journey is efficient. The radiology team reviewed all processes to identify time critical points and streamlined processes accordingly. Prospective data collected pre and post intervention. Statistical methods were applied to analyse the data. Results: Prior to implementation of this initiative, 152 patients received thrombolysis from July 2014 to March 2016. In the 21 months after implementation, 209 patients received thrombolysis (April 2016 to December 2017). Our thrombolysis rate increased from 25.8% prior to 28.8% after the intervention (P1⁄4 0.22). Stroke onset to-needle-time did not differ significantly between the groups (83 minutes vs. 88 minutes, P1⁄4 0.30) but door-to-CT time and door-to-needle time were significantly reduced (31 minutes vs 18 minutes, P< 0.001, and 65 minutes vs 47 minutes, P< 0.001, respectively). Conclusion: By having an inclusive multidisciplinary team simultaneously notified with the addition of a radiographer in the acute stroke team, we improved the thrombolysis rates and door-to-CT time which led to significantly reduced door-to-needle times. Time equals brain – Retrospective analysis of thrombolysis in regional Australia to determine factors which influence door to needle time Udit Nindra, Toni M Wonson and Karen Fuller Neurology, Wollongong Hospital, Wollongong, NSW, Australia A 3 year retrospective cohort analysis of all acute stroke admissions in Wollongong Hospital, a major regional referral centre in New South Wales, was completed to determine the causes of in-hospital delays for thrombolysis. Data collected included age, baseline National Institute of Health Stroke Scale (NIHSS) score, onset time, arrival time, CT imaging & reporting time and outcomes of the event. From 656 admissions, 70 cases of thrombolysis were recorded 56 cases of endovascular thrombectomy. The mean time from onset to arrival was 85 minutes, from arrival to CT was 31 minutes and from door to needle time (DNT) was 108 minutes. Multiple regression analysis revealed an inverse linear association between onset to arrival time and DNT. Age, stroke severity and gender were not shown to impact treatment times. The results showed that there was a paradoxical association between arrival time and DNT. The cause for this was not clearly identified but similar to previous studies is likely to be contributed by a lack of urgency when initiating management. For every 30-minute delay in hospital arrival, there was a 13minute reduction in DNT. In light of this, education trials to promote ‘time equals brain’ understanding amongst stroke first responders is being implemented to aim to reduce DNT to less than 80 minutes. Predictors of good vs bad outcome in patients with acute ischemic stroke post IV thrombolysis Hina Yusuf, Waseem Tariq and Raja Shoaib Shifa International Hospital, Islamabad, Punjab, Pakistan Background: Stroke is a leading cause of premature deaths worldwide. With the advent of IV Thrombolysis (IVT) and Thrombectomy it will be helpful to differentiate patients who can benefit from IVT alleviating the need for Thrombectomy. Aims: To determine predictors of good versus bad functional outcome in patients with acute ischemic stroke (AIS) receiving IVT. Methods: We performed retrospective analysis of clinical records of all patients receiving IVT for AIS from Jan 2015 to Dec 2018. We noted the characteristics of good responders whose NIHSS score improved to 3 or less at one week versus bad responders whose NIHSS did not improve by 5 points at one week. Results: Out of 93 patients treated with IVT for AIS, 33 had marked functional improvement. In 21 patients NIHSS did not improve more than 5 points at one week from baseline of 14 with highest being 23. Average age was 63.6 years and 69.9 years in good and bad responders, respectively. We looked at differences in age, gender, Blood pressure and Blood Glucose on presentation, history of Hypertension and Diabetes, Symptom onset to needle time, Presence of Atrial Fibrillation, Ejection fraction and carotid stenosis, presence of dense MCA sign, initial NIHSS and TOAST classification of stroke. Conclusion: Our observation shows that female gender, normoglycemia, early symptom to needle time, non-cardioembolic strokes, and sub cortical strokes are associated with good functional recovery in AIS in patients treated with IVT. Large scale studies are needed to clearly establish positive predictive role of these factors in patients treated with IVT for stroke. Validation of the NIH stroke scale score for clinical assessment of intracerebral hemorrhage Wendy Dusenbury, Georgis Tsivgoulis, Andrei V Alexandrov and Anne W Alexandrov University of Tennessee Health Science Center, Memphis, Tennessee, United States; National and Kapodistrian University of Athens, Athens, Greece Background: Both Glasgow Coma Scale (GCS) and NIH Stroke Scale (NIHSS) are commonly used as serial assessment tools in ICH, however, the NIHSS lacks formal validation in this population. Methods: We prospectively collected ICH assessments, imaging, and outcome data. Direct comparisons of discrimination were made using GCS and NIHSS on prediction of 24-hour poor functional outcome (mRS-3-6) and hematoma volume >30 cm using ROC analysis; c statistics were calculated and compared with DeLong test. Results: 672 ICH patients (mean age 62 14 years; 56% men; median ICH score1⁄4 1, IQR 0–2; median ICH volume 7 cm, IQR 2–19). Median NIHSS and GCS were 8 (IQR 3–18) and 15 (IQR 7–15) respectively. NIHSS correlated strongly to GCS (r -0.773; p< 0.001). NIHSS (c statistic: 0.91; 95%CI: 0.89-0.93) discriminated better than GCS (c statistic: 0.78; 95%CI: 0.75-0.81) for 24-hour poor functional outcome (DeLong p< 0.001; Figure 1A). NIHSS (c statistic: 0.82; 95%CI: 0.78-0.86) also discriminated better than GCS (c statistic: 0.78; 95%CI: 0.73-0.83) for large hematoma volume (DeLong p1⁄4 0.029; Figure 1B). Conclusions: The NIHSS has a greater discriminative power than GCS to identify patients with poor functional outcomes and large hematoma volumes. International Journal of Stroke 2019, Vol. 14(1S) 3–20 ! 2018 World Stroke Organization Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1747493019858233 journals.sagepub.com/home/wso International Journal of Stroke, 14(1S) International perspectives on head of bed position for intracerebral hemorrhage in the Post-HeadPoST era Wendy Dusenbury, Mark Malkoff, Peter Schellinger, Martin Kohrmann, Adam Authur, Lucas Elijovich, Andrei V Alexandrov and Anne W Alexandrov University of Tennessee Health Science Center, Memphis, Tennessee, United States; Neurology and Neurosurgery, John Wesling Medical Center Minden-Ruhr University Bochum, Minden, Germany; Neur