Abstract Details

Title Immediate Stroke Fellow Presence in the ER: Getting to the Needle Faster

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P04 - (-)

Poster/Presentation
Number 052

Objective

Background BACKGROUND: In 2011, our center exhibited unexpected increases in DTN times. Starting 4/2012, a Stroke Fellow occupied an area near the ED during weekdays (M-F 0700hrs to 1700hrs). We thought immediate Stroke Fellow presence (ISP) near the ED would facilitate faster tPA treatment times.

Design/Methods DESIGN/METHODS: From our stroke registry, we reviewed patients treated with IV tPA from 12/2011 to 7/2012, comparing those who presented during ISP hours with those prior to ISP implementation (pre-ISP). We compared ISP patients with those presenting during comparable daytime hours (CDH) pre-ISP. Primary outcomes were proportion of patients with DTN <60 min who presented within 2 hrs of symptom onset. Secondary outcomes included tPA treatment times.

Results RESULTS: 125 patients were treated with IV tPA in the study period. Of these, 94 presented within 2 hours of symptom onset, with 14 (14.9%) of those in the ISP group. A higher proportion of patients in the ISP group received IV tPA within 60 minutes compared to pre-ISP although not statistically significant (57.1% vs 47.5%; p=0.5055). Compared to those arriving in CDH pre-ISP, there was a similar non-significant difference in proportion treated within 60 min favoring the ISP group (57.1% versus 50%; p=0.675). Secondary outcomes show a significant reduction in median Door-to-CT (19 min vs 25 min; p=0.02) with non-significant reduction in DTN times in the ISP group.

Conclusions CONCLUSIONS: Stroke Fellow presence in close proximity to the ED showed non-significant propensity toward faster treatment. We were limited by small sample sizes, installation of a new CT scanner before ISP and implementation of new pager scheme. Nevertheless, this suggests that immediate presence of a Stroke Neurologist may expedite advocacy, acute diagnosis and treatment of acute ischemic stroke patients.

Authors/Disclosures
Claude Nguyen, MD (Current Neurology Solutions) PRESENTER	Dr. Nguyen has nothing to disclose.
Osman Mir, MD (Texas Stroke Institute)	No disclosure on file
Marilyn Matthew	No disclosure on file
William J. Hicks II, MD (OhioHealth)	Dr. Hicks has nothing to disclose.
Andrew Bursaw, DO	No disclosure on file
Yazan Alderazi, MD, MB BCh BAO (HCA- Houston Healthcare)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Nicole Gonzales, MD (University of Colorado Anschutz Medical Campus)	The institution of Dr. Gonzales has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology.
Tzu-Ching Wu, MD (UT Health McGovern Medical School)	Dr. Wu has nothing to disclose.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
James C. Grotta, MD, FAAN (Memorial Hermann Hospital Life Flight)	Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Frazer Ltd. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Haemonetics. Dr. Grotta has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acticor. Dr. Grotta has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Prolong Pharma. Dr. Grotta has received publishing royalties from a publication relating to health care. Dr. Grotta has received publishing royalties from a publication relating to health care.

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