Abstract T P337: Outcomes for a Cohort of Patients Not Treated with Thrombolytic Therapy Due to Mild or Rapidly Improving Stroke Symptoms: A Retrospective Review
Background: Symptoms too mild and rapidly improving stroke symptoms (RISS) are relative contraindications for thrombolytic therapy (tPA) in acute ischemic stroke patients (AIS), yet several studies indicate that some of these patients may have a poor outcome. Baptist Health System (BHS) includes five Certified Primary Stroke Center hospitals which admit nearly 2,000 ischemic and hemorrhagic stroke patients a year.
Purpose: The purpose of this study is to review the discharge ambulatory status and disposition of the AIS patients that were not treated with tPA because their symptoms were to mild, defined as NIHSS ≤ 5, or with RISS.
Methods: A retrospective review was conducted using GWTG data to determine the total number of AIS admitted between 2011 - 2013, the total number of patients who were eligible for tPA with an NIHSS ≤ 5, and the total number of patients who did not receive tPA because of a documented reason of symptoms too mild or RISS.
Results: From 2011 to 2013, BHS admitted 3,035 AIS patients, of which 396 patients arrived within 3.5 hours of last known well and had an NIHSS ≤ 5. Of those, 317 (80.05%) patients had an exclusion documented of symptoms too mild or RISS. The discharge disposition of these patients include: Home 59.94% (n=190), Acute Rehab Facility 22.40% (n= 71), Skilled Nursing Facility 14.82% (n- 47), Hospice 1.89% (n=6), Left AMA 0.63% (n=2), and Expired 0.31% (n=1). At discharge, the data reveals 51.74% (n=164) were able to ambulate independently with or without a device, 37.22% (n=118) were unable to ambulate without assistance from another person, 10.73% (n=34) were unable to ambulate and 1 patient died.
Conclusions: In conclusion, despite being identified as having a mild and rapidly improving stroke, the patients not treated with IV tPA and an NIHSS ≤ 5 do not necessarily have mild outcomes. The exact reason for these short-term outcomes cannot directly be concluded from this review. This retrospective review of our community cohort shows that there are disabilities and extended care requirements in the context of a mild stroke and more data review, research, evaluation and consideration of the mild stroke patient is indicated.
Author Disclosures: D. Motz: None. J. Sharp: None. T. Moore: None. D. Huey: None. L. Birnbaum: None. T. Austin: None.
- © 2015 by American Heart Association, Inc.