Abstract WP286: Emergency vs. In House Code Stoke: Differences and Similarities
Background and Purpose: The Joint Commission requires consistent evaluation, treatment and services for acute ischemic stroke patients. In house code strokes are an important subset of stroke patients that present outside of the carefully managed environment of the emergency room. We hypothesized a difference in treatment rates, interventions (intravenous thrombolyis IVT vs. intra-arterial thrombolysis with or without mechanical thrombectomy IAT) and mortality for in house code strokes compared to emergency room code strokes.
Methods: This report is a single center review of code strokes from 1/1/09 to 12/31/11. We classified the total code strokes (TCS) as emergency department codes strokes (EDCS) or in house code strokes (IHCS). We then compared demographics, acute stroke interventions, and mortality. Patients who expired in hospital or were discharged to hospice were counted as mortality. We determined the location within the hospital where the in house code stroke occurred.
Results: There were 1207 TCS during the study period. There were 1082 EDCS and 125 IHCS. Baseline demographics for age, gender and ethnicity were similar. TCS acute intervention rate was 30% (360/1207), EDCS acute intervention rate was 32% (341/1082) and IHCS acute intervention rate was 15% (19/125). IVT was the only treatment modality in 75%(262/360) of EDCS with acute intervention. IAT was used as acute intervention in 58%(11/19) of IHCS treated acutely. Mortality for TCS treated with acute intervention was 22% (79/360). EDCS treated with acute intervention had a mortality of 21% (71/341) and IHCS treated with acute intervention had a mortality of 42% (8/19). The IHCS patients had geographically widespread locations within the hospital.
Conclusions: EDCS are more numerous and more likely to get acute intervention with lower mortality compared to IHCS. IHCS are less likely to be candidates for acute intervention, more likely to have IAT, and the IHCS patients treated with acute intervention have a higher mortality rate. Educating staff to recognize IHCS is difficult because of the wide range of locations of IHCS within the hospital.
- © 2012 by American Heart Association, Inc.