Abstract Details

Title Use of SMART IV Thrombolysis Criteria at Community Hospitals Is Safe

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 074

Objective

Background BACKGROUND: Thrombolysis rates remain low nationally (1-3%)[sup1]. The SMART criteria expand rt-PA use by reducing exclusion criteria. When applied to all acute ischemic stroke (AIS) patients at a large CSC, the thrombolysis rate increased to 25-30%, with low symptomatic intracranial hemorrhage (sICH) rates[sup2]. This study investigates the safety of applying these criteria to AIS patients who transferred from outside community hospitals.

Design/Methods DESIGN/METHODS: Retrospective study of all AIS patients treated with IV rt-PA from 10/1/2008-8/1/2012 at the local CSC ED or an outside hospital before transfer to the CSC. Baseline characteristics, admission status, and stroke severity were obtained. Primary outcomes included NIHSS and discharge disposition. Safety was determined by sICH rate.

Results RESULTS: 427 AIS patients received IV rt-PA. 213 were local and 214 transferred. sICH rate was 1%. Excluding expired patients, transfers had significantly higher mean NIHSS at both admission (8.2 vs. 6.7) and discharge (5.7 vs. 3.5). However, mean improvement in NIHSS was not significantly different between transfer vs. ED patients (p=0.213). Transferred patients were younger and had a higher mortality rate (14% vs. 6.6%, OR=2.32[1.19-4.5], p=0.011), but there was no significant difference in length of stay or number of patients being discharged to home or acute rehab (123 transfers vs. 141 EDs, OR=0.829[0.538-1.279], p=0.397).

Conclusions CONCLUSIONS: Applying the SMART criteria to patients receiving IV rt-PA via telemedicine or telephone before transfer to a CSC is safe. Transferred patients have more severe strokes and associated higher mortality consistent with the need for transfer, but were discharged to home and rehab at comparable rates. [sup1] Ann Emerg Med. 2007; 50(2):99-107. [sup2] Presented at AAN Annual Meeting; April, 2010; Toronto, Canada.

Authors/Disclosures
Sigrid B. Sorensen PRESENTER	No disclosure on file
nobl barazangi, MD, PhD	Dr. Barazangi has nothing to disclose.
Christine S. Wong, MD	No disclosure on file
Charlene Chen, MD (Denali Therapeutics)	No disclosure on file
Jack C. Rose, MD (Washington Township Medical Group)	No disclosure on file
	No disclosure on file
	No disclosure on file
David C. Tong, MD, FAHA	No disclosure on file
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.

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