Abstract Details

Title Rate of Utilization and Determination of Withdrawal of Care among Acute Ischemic Stroke Patient Treated with Thrombolytics

Topic Ethics, Pain and Palliative Care

Presentation(s) P02 - (-)

Poster/Presentation
Number 002

Objective

Background BACKGROUND: Current practices for utilization of thrombolytics are based on results of clinical trials with no or restricted use of "withdrawal of care" among treated patients. The increasing use of "withdrawal of care" in routine practice may lead to suboptimal outcomes among acute ischemic stroke patients treated with thrombolytics.

Design/Methods DESIGN/METHODS: We determined the frequency of "withdrawal of care" and compared the demographic, clinical characteristics, and in-hospital outcomes among thrombolytic treated ischemic stroke patients stratified by use of "withdrawal of care".

Results RESULTS: "Withdrawal of care" during hospitalization was instituted in 4327 (3.1%) of the 136854 acute ischemic stroke patients treated with thrombolytics. The mean age [±standard deviation] of the patients who underwent "withdrawal of care" was significantly higher (79±11.5 years versus 68±14.7, p<0.001). In the stepwise logistic regression, women (odds ratio [OR] 1.4, 95% confidence interval [1.1-1.7]), presence of atrial fibrillation (OR 2.1, 95% CI 1.8-2.5), and intracerebral hemorrhage (OR 3.2, 95% CI 2.5-4.1) were significant predictors of "withdrawal of care" among thrombolytic treated ischemic stroke patient. Large sized hospitals (OR 1.5, 95% CI 1.1-2.0), and teaching hospitals (OR 1.4, 95% CI 1.0-1.9) were more likely to use withdrawal of care. The rate of intubation and mechanical ventilation were significantly higher among patients who underwent "withdrawal of care". In-hospital mortality (61% versus 8.6%, p=<0.0001) and the mean hospitalization charges ($84,072±79674 versus $69,104±75014, p<0.0001) were significantly higher among those with "withdrawal of care".

Conclusions CONCLUSIONS: Our results identify several individual and institution related factors that determine the use of "withdrawal of care" among thrombolytic treated ischemic stroke patients. The excessively high mortality and resource utilization mandates a more evidence based policy for "withdrawal of care" in these patients.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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