The authors report a case of spontaneous spinal epidural hematoma causing paraplegia secondary to a qualitative platelet disorder from excessive garlic ingestion. The case also demonstrates satisfactory recovery from thoracic spinal epidural hematoma in a nonagenarian. Recovery from severe spinal cord compression can occur even in the very elderly.
The authors report a case of spontaneous spinal epidural hematoma causing paraplegia secondary to a qualitative platelet disorder from excessive garlic ingestion. The case also demonstrates satisfactory recovery from thoracic spinal epidural hematoma in a nonagenarian. Recovery from severe spinal cord compression can occur even in the very elderly.
INTRODUCTION: Patients' perceptions of healthcare quality have become an important part of quality measurement. We explored patients' and family's lived experiences during acute stroke hospitalization to develop a quantitative instrument. METHODS: Focus groups were conducted using open-ended scripted questions. Interview data were coded and analyzed using an inductive approach to thematic analysis. Symmetric patient and family instruments were developed based on qualitative domains and serially refined to a set of 30 survey items, 12 stroke knowledge test items, and 5 subject demographic fields. Scales were evaluated for internal consistency reliability using Cronbach α; construct validity with exploratory factor analysis using principal components with varimax rotation was performed to determine the extent to which items in a scale measure the same underlying factor. Feasibility of an electronic cloudbased survey was also tested. RESULTS: Three main themes emerged: fast action to diagnose and treat stroke, genuine caring, and education to prevent and respond to stroke. A total of 1029 subjects completed the final instrument with no differences in perception found by race, ethnicity, or length of stay.
The Michigan Stroke Network provides telestroke services at 32 hospitals across Michigan. These include several critical access hospitals and free standing emergency rooms (ERs). The network conducts ongoing education of member hospitals, emphasizing rapid recognition of symptoms and early activation of the stroke network. Our hypothesis was that prompt communication with a stroke neurologist will facilitate processes and decision making; reducing door to needle times for patients receiving tPA
Methods:
Data was collected for all video consultations. For patients who received tPA, time of symptom onset, time of arrival at member hospital, time of call to network and door to needle times were recorded. Data from January 2012-March 2013 are presented in this abstract; further prospective data collection is ongoing.
Results:
Over 15 months, 249 consultations were performed, resulting in 42(16.8%) tPA administrations and 110(44.2%) transfers for endovascular therapy or post tPA care. A door to needle time<60 min was achieved in 17 of 42(40.4%). Three patients received tPA for symptoms starting within the hospital. Of 33 patients who arrived within 2 hours of symptom onset, 27(81.8%) received tPA within 3 hours.
When the stroke network was activated within 20min of patient arrival, 9/10 patients received tPA within 60 min; whereas if the network was not activated within 20min, only 8/29 achieved this target(p=0.0009). In conclusion, involving the on-call neurologist in a telemedicine network facilitates early decision making and results in shorter door to needle times. Quality improvement initiatives within a hospital network should concentrate on improving front end processes for early identification of stroke symptoms and prompt communication with the stroke neurologist.
Introduction:
Telemedicine for patients with acute stroke represents a method to extend neurologic expertise to hospitals without established Stroke Teams. The Michigan Stroke Network (MSN) is a comprehensive telestroke service providing emergency stroke consultations at 34 spoke hospitals throughout Michigan since 2007. Several non-member health systems also contribute patients to the hub, St. Joseph Mercy Oakland Hospital (SJMO) in Pontiac, MI. Maintaining a large telestroke network is a demanding practice due to the geographic coverage, multidisciplinary communication, need for precision in remote neurological examination and PACS viewing, and rapid and complex decision making.
Objective:
To evaluate the sustainability of a statewide telemedicine stroke network.
Results:
Telestroke utilization data from 2008-2011 were prospectively collected from MSN member hospitals and are provided in the attached table. Patients were more likely to be transferred if endovascular intervention was planned. Although the percentage of transferred patients for intervention decreased somewhat over time, this likely reflects improved efficiency of triaging appropriate revascularization candidates.
Conclusions:
Our results demonstrate the feasibility of maintaining a large statewide telemedicine network. The steady call volumes demonstrate the value of facilitated acute stroke decision making at hospitals without established Acute Stroke Teams. The turnaround time for the consultant and time for robot activation remained stable. Consult duration was slightly increased in 2011 as compared to prior years. A substantial number of patients were candidates for acute stroke intervention each year. On average, patients receiving IV-tPA through MSN experienced a >7-point reduction in NIHSS by the end of their hospital stay. 30-day follow-up NIHSS/mRS were not available at the time of this analysis.
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