Do acute ischemic stroke patients receive the right treatment in non-stroke units?

Abstract

Abstract:Background: Modern treatment of acute ischemic stroke includes thrombolysis and thrombectomy performed for eligible patients in specialized stroke centers. However, a number of patients are admitted in Neurosurgical or Intensive Care Departments of emergency hospitals, units where routine treatment strategies are applied. Objective: To evaluate the management of patients admitted in these departments that do not benefit from thrombolytic or endovascular treatment. Methods: A retrospective analysis was performed, including all patients admitted to the Neurosurgery Department and Intensive Care Unit (ICU) of the "St. Pantelimon" Clinical Emergency Hospital with the primary diagnosis of acute ischemic stroke in the year 2016. The following data was retrospectively collected: patient age and sex, comorbidities, risk factors for ischemic stroke, level of consciousness at admission, neurological deficits, stroke location, blood glucose levels, interval from stroke onset to admission, treatment and discharge status. Results: In 2016, 63 patients with primary diagnosis of acute ischemic stroke confirmed by head CT scan were admitted in our hospital. None presented indication for decompressive craniectomy. Over a half of them (57,14%) were comatose. The majority of patients admitted to the ICU (76,47%) received glucose 10% infusions in the first 24 hours from admission, despite increased blood glucose levels at admission. A number of 38 (60,32%) of these patients died. Conclusions: Patients with acute ischemic stroke should be treated in stroke units with proper equipment and specialists. National public health institutions should take the necessary measures in order to ensure that patients get to the best facility in order to receive the right therapy in the right amount of time.