Abstract TP339: Stroke Severity Scoring: A Bi-variate Analysis of Clinical Outcomes Post Intravenous t-PA as a Guide to Influence Potential Change in Clinical Practice
Background: Care of the acute stroke patient in a dedicated stroke unit or ICU has been associated with improved outcomes. Not all post tPA patients require ICU level care, however general practice is admission to the ICU for 24 hours following tPA administration. In a Certified Primary Stroke Center nestled in the buckle of the stroke belt, 800+ patients with a primary diagnosis of stroke are admitted annually. There is a dedicated stroke unit with continuous multichannel telemetry. All post tPA patients are admitted to the medical ICU for the first 24 hours.
Purpose: Hospitals administering intravenous tPA should continuously evaluate the impact of patient selection, unit placement and overall outcomes to include clinical efficiency, cost effectiveness, quality, safety, complications and deaths. Partnering with critical care physicians to evaluate stroke severity scores is essential for empirical consideration.
Methods: Data analysis of clinical elements that may predict patient outcomes and serve as a guide to influence change in clinical practice was reviewed.
Bi-variate analysis of stroke severity scores, whereby the first National Institute of Health Stroke Scale (NIHSS), < 15 and > 15
Review of comorbities
Blood pressure control
Complications to include symptomatic bleeding
Results: Clinical outcomes of 171 patients post tPA administration were reviewed over a two year period.
• 80% of patients with NIHSS < 15 were discharged to home or rehab
• 42% of patients with NIHSS > 15 were discharged to home or rehab
• Four deaths occurred in patients with NIHSS < 15. Three deaths unrelated to tPA administration included one cardiac arrest and two respiratory failure. The fourth death, a regional transfer with advanced age, complex comorbities and uncontrolled blood pressure, resulting in a symptomatic bleed.
• 16 deaths occurred in the patients with NIHSS > 15
Conclusions: Analytical review of outcome data, specifically stroke severity scores, should serve to influence ICU admission criteria and processes. Engagement of board certified neurocritical physicians or intensivists supports empirical evidence for improved utilization of resources and critical care beds using NIHSS < 15 as a reference.
- © 2012 by American Heart Association, Inc.