Abstract 180: Stroke Mimics in Drip and Ship Thrombolytic Therapy
Introduction: Drip and ship (DS) thrombolysis provides immediate acute ischemic stroke treatment and follow-up tertiary stroke care at a certified Comprehensive Stroke Center (CSC) for one quarter of the US population living in rural areas. Studies reveal that patients with stroke mimic (SM) inadvertently receive treatment due to lack of immediate access to specialists and the limited treatment time window.
Hypothesis: We hypothesized that a higher percentage of SM would receive thrombolysis via the DS paradigm than those directly presenting to the CSC.
Methods: We reviewed consecutive DS tPA cases transferred to the University of Louisville Hospital (ULH) and tPA cases originating at ULH from January, 2013 to June, 2015. ULH is a CSC that provides rural Kentucky and Southern Indiana hospitals with 24-hour telephone access to stroke specialists. We compared the percentage of SMs via a DS paradigm to those originating at ULH. SM data collected included demographics, medical history, NIHSS, complications, discharge diagnosis, discharge disposition, and the length of hospitalization. Etiology of SM was evaluated in the Old (≥ 65 years old) and the Young (<65 years old) group, respectively. Comparative analyses with t-tests and Fisher Exact tests were performed.
Results: Total numbers of tPA cases were similar between the DS (201) and the ULH (200) groups, but the percentage of SM in the DS group was double the ULH group (27.4% vs 13.5%). Clinical features, NIHSS on admission, and percentage of SM patients who were 65 years or older were similar in both groups. None of SM had intracranial hemorrhage or severe adverse events. One patient in the DS had minor hematemesis without transfusion. All except one patient returned home or to an assisted living facility. One patient who was from home was discharged to a nursing home due to Parkinson’s disease. Psychiatric disease was more common in the Young SM than the old (45.3% vs 7.4%, p < 0.05). Encephalopathy for various reasons (25.9%) and seizures (22.2%) were the two most common causes in the Old SM.
Conclusions: SMs are treated with tPA more often in the DS paradigm than when presenting to a CSC. Although the thrombolysis caused no harm, adequate access to specialists (i.e telestroke) may decrease unnecessary treatment with tPA.
Author Disclosures: G.P. Dighe: None. A. Kumar: None. M.F. Bilal: None. T. Abrol: None. K. Moore: None. E. Wise: None. A. Jerde: None. L. Bystrek: None. J. Shah: None. M. Wilder: None. K. Remmel: None. W. Liu: None.
- © 2016 by American Heart Association, Inc.