Simulation training is a beneficial part of medical education for APPs and should be considered in addition to traditional didactics and clinical training. Further research is needed to determine whether simulation education of APPs results in improved treatment times and outcomes of acute stroke patients.
BACKGROUND AND PURPOSE Infarct core assessment on presentation is important to evaluate salvageable tissue to select patients for thrombectomy. Our study aims to evaluate the correlation between infarct core volume measured by computed tomography (CT) perfusion (CTP) and magnetic resonance diffusion‐weighted imaging (MR‐DWI) in patients with acute large‐vessel occlusion. METHODS We studied patients who underwent CTP on presentation to the emergency department for stroke symptoms. National Institute of Health Stroke Scale (NIHSS), collateral status, symptomatic vessels, and modified Rankin scale (mRS) at 90 days were collected. Admission infarct core volume was measured on initial relative cerebral blood volume and final infarct core volume on follow‐up DWI. The correlation between two measures was assessed using Pearson's correlation coefficient. RESULTS Seventy‐four patients were studied of which 41.9% were female. Median NIHSS was 13 (2‐30). Middle cerebral artery occlusion was present in 53 (71.6%) patients and 54 (72.9%) had good collaterals. Good functional outcome of mRS 0‐2 was achieved by 60.8% at 90 days. There was a strong correlation between CTP and MR‐DWI (r = .94). There was no significant difference between volume (in milliliters) on CTP (54.1 ± 69.8) and volume on DWI (50.3 ± 59.7; P = .18) using the paired t‐test. CONCLUSION CTP provides a good estimation of the core infarct volume. It performs well within the clinically relevant thresholds for patient selection for thrombectomy.
BACKGROUND AND PURPOSE: Recent trials have shown benefit of thrombectomy in patients selected by penumbral imaging in the late (>6 hours) window. However, the role penumbral imaging is not clear in the early (0-6 hours) window. We sought to evaluate if time to treatment modifies the effect of endovascular reperfusion in stroke patients with evidence of salvageable tissue on CT perfusion (CTP). METHODS: We retrospectively analyzed consecutive patients who underwent thrombectomy in a single center. Demographics, comorbidities, National Institute of Health Stroke Scale (NIHSS), rtPA administration, ASPECTS, core infarct volume, onset to skin puncture time, recanalization (mTICI IIb/III), final infarct volume were compared between patients with good and poor 90-day outcomes (mRS 0-2 vs. 3-6). Multivariable logistic regression analyses were used to identify independent predictors of a good (mRS 0-2) 90-day outcome. RESULTS: A total of 235 patients were studied, out of which 52.3% were female. Univariate analysis showed that the groups (early vs. late) were balanced for age (P = .23), NIHSS (P = .63), vessel occlusion location (P = .78), initial core infarct volume (P = .15), and recanalization (mTICI IIb/III) rates (P = .22). Favorable outcome (mRS 0-2) at 90 days (P = .30) were similar. There was a significant difference in final infarct volume (P = .04). Shift analysis did not reveal any significant difference in 90-day outcome (P = .14). After adjustment; age (P < .001), NIHSS (P = .01), recanalization (P = .008), and final infarct volume (P < .001) were predictive of favorable outcome. CONCLUSIONS: Penumbral imaging-based selection of patients for thrombectomy is effective regardless of onset time and yields similar functional outcomes in early and late window patients.
Introduction: Stroke quality programs aim to ensure patients receive evidence based care by measuring patient outcomes and adherence to core measures. Site specific stroke order sets embedded in EHRs augment core measure performance. The true benefit of stroke order sets on core measure performance is still an open question. We hypothesize that utilizing stroke specific order sets increases compliance to core measures and subsequently decrease length of stay (LOS) and readmissions. Methods: A retrospective cohort study was conducted, and included 1095 stroke patients discharged between May 1, 2017 and April 30, 2018. Hospital data was extracted from The Joint Commission stroke registry and supplemented with administrative data. The primary outcome was core measure compliance and was analyzed using Chi-square and Cochran-Mantel-Haenszel tests. Results: The majority of stroke patients (1009, 92%) had a stroke admission order set. Between the order set and non-order set groups there were significant differences in age ( p =.03), stroke type ( p <.001), and EHR system ( p =0.002). The order set group had a marginal decrease in LOS (days) compared with the non-order set group, 3 and 3.9, respectively ( p =.06). Unplanned readmissions within 30-days did not differ between groups ( p =.16). For ischemic stroke, phase specific order set usage showed significantly higher core measure compliance: venous thromboembolism prophylaxis (STK1) (94.0% vs 6.0%, p =.01), antithrombotic by end of hospital day two (STK5) (96.9% vs 73.3%, p <.001), discharged on statin medication (STK6) (99.8% vs 97.5%, p =.006), stroke education (93.3% vs 47.1%, p <.001) (STK8), and national institute of health stroke scale within 12 hours of arrival (CSTK1) (95.8% vs 44.1%, p <.001). The hemorrhagic stroke population showed no significant differences between order set usage and core measure compliance. Conclusion: Use of stroke specific order sets decreased overall LOS and increased compliance to STK1, STK5, STK6, STK8, and CSTK1 core measures.
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