253 A registry of current practice to improve the care of stroke patients in Haute Garonne

Abstract

ObjectivesA stroke is an emergency that must be investigated early and rapidly to find the cause and give appropriate treatment. When a stroke is suspected it is recommended in the first instance to call the medical emergency telephone centre (Centre 15). The aim of this registry was to study the emergency care managment followed for suspected stroke patients and to evaluate the impact of the recourse to the Centre 15ProgramIn April 2008 a registry of current practice was established by the Observatoire Régional des Urgences de Midi-Pyrénees within all the public emergency services of the Haute Garonne. All patients over the age of 18 suspected or having an acute stroke were included by the call-centre of the prehospital (SAMU31, SMUR) or the emergency services.The current evaluation concerns the patients taken care of by the St Gaudens Hospital Centre (SMUR and emergency department) over a period of 15 months. This establishment covers a population catchment's of 75 000 inhabitants and is situated in the south of the Department, one hour from the Toulouse University Hospital which houses the neurovascular unit and the SAMU. The St Gaudens Hospital Centre has a CT scan but no neurological specialist.ResultsTwo hundred twenty six patients were included in the study between the 1st of April 2008 and the 30th of June 2009. They had a mean age of 79 (range 32-97) and a sex ratio of 0.45. The completion rate was 100%.Fifty eight per cent of the patients were stabilised by the SAMU31, either as a result of a direct call to the centre 15 or after contact made by an independent doctor, and of these patients 9.3 % were taken by the SMUR in St Gaudens. Among the patients arriving directly at the emergency department (ED) without prior stabilisation (42 %), 56 % had contacted an independent doctor in the first instance.The median delay ‘onset of symptoms—arrival at the ED’ for all patients was 151 min (range 86–352). It was shorter (146 vs 155 min; p=0.67) for stabilised patients. The median length of time in the ED was 210 min overall and was shorter for the stabilised patients (190 vs 239 min; p=0.06). The delay between arriving in ED and clinical examination was significantly shorter for stabilised patients (11 vs 26 min; p<0.0001). A neurologist at the University Hospital was contacted by the emergency physician for 29 % of all patients; 25 % of the stabilised patients and 34 % of the non-stabilised (p=0.13). The results of thrombolysis are currently being consolidated and will be available for the symposium.DiscussionThe registry enables the care systems to be objectively compared and our results confirm the positive clinical impact of an intervention following a call to the centre 15: a shorter time in emergency and earlier treatment. The gain in time is estimated to be 15 min, which enables the rate of patients eligible for thrombolysis to be increased. However, only 58% of patients follow this route.This record will enable us to evaluate the impact of (1) setting up information campaigns on the rate of initial calls ...