Abstract Details

Title Utility of a Routine 24-Hour Follow-Up Computed Tomography Scan in Patients with Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 238

Objective

Background BACKGROUND: Evidence is lacking for the utility of a routine 24-hour CT in AIS patients treated with tPA when early neurological deterioration (END) does not occur.

Design/Methods DESIGN/METHODS: Consecutive AIS patients given tPA between June 2008 and December 2011 were retrospectively identified. Cases were excluded if intra-arterial treatment was received (n=15), a 24-hr CT was not performed (n=9), or 24-hr NIHSS score was not documented (n=6). The remaining cases were divided into: END (>/=2pt increase in NIHSS) and No END. Baseline characteristics and medical history, 24-hr computed tomography (CT) scan findings, new medical and/or surgical orders within 6 hours of imaging, and administration of anti-thrombotics by 10 a.m. the following day were compared between the two groups.

Results RESULTS: Two-hundred cases met criteria: END n=26 and No END n=174. Median age was significantly higher in the END group compared to no END (77 vs. 63 years, p<0.01). Abnormal CT findings were found more often among patients with END (88.5% vs. 59.2%, p<0.01). END increased odds of detection of a parenchymal hematoma (OR 37.5, 95%CI 2.8-507.5, p=0.006). Additionally, new management orders were placed more frequently for patients with END (46% vs. 20%, p=0.002), including DNR/ DNI orders (12% vs. 0.57%, p< 0.01). Alternatively, anti-thrombotics were not withheld with a significantly increased frequency after END (50% vs. 32%, p = 0.065).

Conclusions CONCLUSIONS: While END was associated with hemorrhage and acute management changes, including decisions to limit intervention, a routine 24-hour CT may not be warranted amongst tPA patients without END. Alarmingly, one-third of patients without END experienced unnecessary delay in first antithrombotics, possibly due to waiting on the interpretation of a routine post-tPA CT scan.

Authors/Disclosures
Alexander George PRESENTER	No disclosure on file
Amelia K. Boehme, PhD (Columbia University)	Dr. Boehme has nothing to disclose.
Casey R. Dunn, MD (Washington University Department of Neurology)	No disclosure on file
	No disclosure on file
	No disclosure on file
James E. Siegler III, MD (University of Chicago)	Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.
	No disclosure on file
Karen C. Albright, DO, DO, PhD, MS, MPH (FDA)	Dr. Albright has nothing to disclose.
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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