Abstract W P263: Rapidly Resolving Symptoms..Stop the Race! No Symptoms, No Alteplase!
Background: Research has shown that one-third of patients not treated with thrombolytic therapy due to minor or rapidly improving symptoms have poor outcomes that are considered disabling. The purpose of this study was to determine if opportunities were missed to treat with Alteplase.
Research Question: What is the outcome of patients arriving to the emergency room with symptoms of an ischemic stroke not treated with Alteplase because of rapidly improving symptoms?
Method: A retrospective analysis of patients between January 2012 and February 2013 with ischemic stroke or TIA, whose ICD-9 coding at discharge is in alignment with the Joint Commission and the American Heart Association. STK 4 from the Joint Commission was used to define the population. Patients with documentation from the physician stating that no Alteplase was given due to rapidly resolving symptoms were included. Magnetic resonance imaging and National Institute of Health scores were used along with clinical symptoms to diagnose potential stroke.
Results: Of 47 patients reviewed, 34% had positive imaging and were coded with an ischemic stroke code and 66% had negative imaging and were coded with a transient ischemic attack code. Of the 34% with positive imaging, 38% were discharged to home with home health for therapy follow-up. Of the 66% with negative imaging, 19% were discharged home with home health for therapy follow-up. Of the 47 patients, 6% had a National Institute of Health stroke scale score of 1-3 with positive imaging and 4% had a score of 4 or greater with positive imaging.13% had a score of 0 on admit and 0 on discharge with positive imaging.
Conclusion: We found a third of patients who did not receive Alteplase due to rapidly resolving symptoms did have a stroke and several required therapy services after discharge for residual deficits that were potentially disabling. In addition, the National Institute of Health Stroke Scale was not consistently beneficial in diagnosing acute stroke for patients with normal or low scores who were ultimately diagnosed with stroke.
Author Disclosures: S.L. Smith: None. M.C. Schultz: None.
- © 2014 by American Heart Association, Inc.