Abstract T MP84: Early Specialist Management of In-Hospital Stroke Patients
Background and Objectives: In-hospital stroke (IHS) is associated with high mortality and disability but management is delayed compared with out of hospital stroke presenting to emergency rooms. The hypothesis prior to data collection was that early referral and specialist management of IHS patients will be associated with lower mortality and better functional outcomes at 90 days.
Methods: Pre-specified analysis of prospective registry data of consecutive hospitalised stroke patients between January 2009 and December 2010 fulfilling the criteria: 1) admission to hospital with a non-stroke diagnosis; 2) onset of new neurological deficits after admission; 3) CT/MRI confirmation of new ischaemic or haemorrhagic changes.
Intervention: Early referral and specialist management of IHS within 3 hours of symptom onset versus late referral after 3 hours. Specialist management consisted of neurological assessment, thrombolysis if appropriate, vascular investigations, anti-thrombotic treatment and transfer to stroke unit for physiological optimisation and prevention of complications.
Main Outcomes: Blinded assessment of dichotomised modified Rankin Scale (mRS) score of 0-2 and all-cause mortality at 90 days. All patients completed 90 day follow up.
Results: Eighty four (4.6%) of 1836 stroke patients had IHS (mean age 74 years; 51% male), of whom 78 were ischaemic and 6 haemorrhagic. There were no significant differences in baseline characteristics between 53 (63%) early and 31 (37%) late referrals. Thrombolysis was performed in 29 of the 37/78 (47%) potentially eligible patients. Early specialist management improved functional outcomes (mRS 0-2 at 90 days 40% v 7%, p=0.001) but not all-cause mortality (32% v 37%, p=0.74). Early specialist management was an independent predictor of mRS 0-2 at 90 days [OR 1.13 (95% C.I. = 1.10-1.27), p=0.002] after adjusting for age, cause for hospital admission, stroke severity and thrombolysis.
Conclusions: Early referral and specialist management of IHS patients improved functional outcomes but did not reduce mortality at 90 days, independent of thrombolysis. Further studies are needed to confirm its benefit in wider clinical practice.
Author Disclosures: D. Manawadu: None. J. Choyi: None. L. Kalra: None.
- © 2014 by American Heart Association, Inc.