Abstract TP392: Temporal Trends in Practice Patterns for Acute Ischemic Stroke Workup: A Population-Based Study
Background: Approximately 5%-18% of patients with ischemic strokes will have recurrent stroke within 90 days of the initial event. Establishing stroke etiology is essential to identify treatable conditions that may reduce risk of recurrence. Our objective was to determine practice patterns for the inpatient workup of acute ischemic stroke types in our population over time.
Methods: We reviewed stroke-related diagnostic testing for first-ever hospitalized ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region of 1.3 million people from all 16 adult area hospitals during three one-year study periods (7/93-6/94,1999, and 2005). Seminal studies supporting assessment of the heart and extracranial vessels had been published by 1991. Therefore we defined a “complete workup” to be echocardiography and/or history of atrial fibrillation and evaluation of extracranial arteries. Risk factor screening and the frequency of less common tests were also explored.
Results: Rates of complete workups for 1993-94, 1999, and 2005 were 50%, 58% and 74% (p<0.0001 for trend), respectively (Table 1). There was no association between stroke admission volume and rate of complete workup (r=-0.25, p=0.33; r=0.49, p=0.05; and r=0.03, p=0.90, respectively).
Conclusion: A significant increase in the use of an evidence-based stroke workup was observed for 2005, compared with 1993-94 and 1999. It should be noted that our rates may be underestimates of appropriate testing as some may have occurred in the outpatient setting and others may have had appropriately limited testing. In the future it will be important to determine whether these rigorous, evidence-based workups translate into reduction of recurrent strokes on the population level.
- © 2012 by American Heart Association, Inc.