Abstract Details

Title Diurnal Distribution of Patients Presenting at the Emergency Department with Acute Ischemic Stroke and Its Impact on Functional Outcome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 196

Objective

Background BACKGROUND: A circadian rhythm of acute ischemic stroke onset is established but the diurnal pattern of presentation to the ED is not. Factors influencing patient presenting at the ED during different times of the day are not delineated. ED crowding due to peak patient attendances may strain the available resources and impact on patient outcomes.

Design/Methods DESIGN/METHODS: We conducted a prospective observational study on consecutive acute ischemic stroke patients presenting to the ED at a tertiary hospital from August 2010 to March 2011 in Singapore. The time of symptoms onset and arrival at the ED, demographics, National Institute of Health Stroke Scale (NIHSS) and modified Rankin score (mRS) were recorded. Diurnal pattern of time of arrival at the ED based on the time-intervals from onset of symptoms were determined. We evaluated for clinical factors that were associated with peak and nadir attendances at the ED.

Results RESULTS: 524 patients attended the ED with acute ischemic stroke, 417 (79.6%) had clear onset time of stroke symptoms. The peak (?75 percentile) attendance occurred between 1000 to 1600 hours (46.0% over 7 hours) while a nadir (?25 percentile) occurred from 0100 to 0700 hours (6.1% over 7 hours). A greater proportion of patients who attended ED during the nadir period presented with worse stroke severity (NIHSS, p=0.044) but no difference was observed in function (mRS, p=0.492) on discharge. No diurnal pattern was observed in patients who arrived at the ED within 3 hours of onset of symptoms.

Conclusions CONCLUSIONS: A distinct diurnal pattern of ED arrival for acute ischemic stroke is observed with peak attendance in late morning. This was not associated with poorer functional outcome.

Authors/Disclosures
Tian Ming Tu, MD (Neurology Care Partners) PRESENTER	Dr. Tu has nothing to disclose.
	No disclosure on file
	No disclosure on file
Kim En Lee, MBBS, MRCP (Lee Kim En Neurology Pte Ltd)	No disclosure on file
Jorg Wissel	No disclosure on file

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