Abstract TP59: Rapid MR in Suspected Acute Stroke: Identifying Mimics That Can Avoid Admission
Introduction: Diffusion weighted MR imaging (DWI) is the most accurate method to confirm or exclude acute ischemic stroke, however due to logistics is not widely used in the emergent setting. While many patients with stroke symptoms will get an MRI during their hospitalization, it may occur only after hours of care in the ER or after admission.
Hypothesis: Providing emergent MR imaging in Stroke Code patients avoids unnecessary admission and associated costs for work-up of stroke mimics which otherwise would not be rapidly identified.
Methods: IRB-approved retrospective review of the first year of expedited acute stroke MR imaging availability at a TJC Comprehensive Stroke Center. Imaging included immediate non-contrast head CT on arrival with CT Angiography at discretion of Stroke Code Leader. Emergent MR was then performed in patients without MRI contraindications who had unclear diagnosis, or to clarify extent of infarct. Demographic, clinical and imaging data were analyzed with time from triage to imaging, tPA decision, and discharge.
Results: MRI was performed prospectively in 68/456 patients presenting with possible acute stroke symptoms from 7/1/2014-7/1/2015 (44 male, 26 female, age 60+/-15 years). Symptom onset was within 3 hours in 34 (49%), 3-6 hours in 12 (17%) and >6 hours or awoke with symptoms in 22 (31%); NIHSS of 4 or less in 40 (59%). Median time from arrival to completion of non-contrast head CT was 16 minutes; median time from CT imaging to completion of DWI was 39 minutes. Twenty-nine patients were discharged directly from the ER after MRI, with median ER stay of 5 hours, 15 minutes.
Conclusions: Through multi-departmental collaboration, expediting MR imaging in the setting of acute stroke evaluation can avoid unnecessarily prolonged ER observation and admission in patients with stroke mimics.
Author Disclosures: J. Bykowski: None. N. Gaines: None. B. Meyer: Research Grant; Significant; NIH StrokeNet- U10NS086535. Speakers' Bureau; Modest; Genentech. D. Meyer: None. T. Hemmen: None. W.G. Bradley: None. R. Modir: None.
- © 2016 by American Heart Association, Inc.