<i>Canadian Stroke Best Practice Recommendations</i>: Acute Inpatient Stroke Care Guidelines, Update 2015

Casaubon, Leanne K.; Boulanger, Jean-Martin; Glasser, Ev; Blacquiere, Dylan; Boucher, Scott; Brown, Kyla; Goddard, Tom; Gordon, Jacqueline M.; Horton, Myles; Lalonde, Jeffrey; LaRivière, Christian; Lavoie, Pascale; Leslie, Paul; McNeill, Jeanne; Menon, Bijoy K; Moses, Brian; Penn, Melanie; Perry, Jeff; Snieder, Elizabeth; Tymianski, Dawn; Foley, Norine; Smith, Eric E.; Gubitz, Gord; Hill, Michael D.; Lindsay, Patrice

doi:10.1177/1747493015622461

Cited by 65 publications

(71 citation statements)

References 20 publications

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“…A higher proportion of patients with a diastolic blood pressure of >85 mm Hg and those taking warfarin were observed to have subarachnoid hemorrhage, intraparenchymal hemorrhage, or subdural hematoma but these factors have no known impact on the incidence of brain tumors. Three articles identified some degree of neurologic deficit as being a strong indicator for head CT; however, such would be the case even in the absence of a syncopal event . Two studies in our review reported underlying parenchymal or intraparenchymal infarct, which likely is the cause of neurologic deficits among patients enrolled in these studies .…”

Section: Discussionmentioning

confidence: 81%

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review

Viau

Chaudry

Hannigan

et al. 2019

Academic Emergency Medicine

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Background: Overuse of head computed tomography (CT) for syncope has been reported. However, there is no literature synthesis on this overuse. We undertook a systematic review to determine the use and yield of head CT and risk factors for serious intracranial conditions among syncope patients. Methods:We searched Embase, Medline, and Cochrane databases from inception until June 2017. Studies including adult syncope patients with part or all of patients undergoing CT head were included. We excluded case reports, reviews, letters, and pediatric studies. Two independent reviewers screened the articles and collected data on CT head use, diagnostic yield (proportion with acute hemorrhage, tumors or infarct), and risk of bias. We report pooled percentages, I 2 , and Cochran's Q-test.Results: Seventeen articles with 3,361 syncope patients were included. In eight ED studies (n = 1,669), 54.4% (95% confidence interval [CI] = 34.9%-73.2%) received head CT with a 3.8% (95% CI = 2.6%-5.1%) diagnostic yield and considerable heterogeneity. In six in-hospital studies (n = 1,289), 44.8% (95% CI = 26.4%-64.1%) received head CT with a 1.2% (95% CI = 0.5%-2.2%) yield and no heterogeneity. In two articles, all patients had CT (yield 2.3%) and the third enrolled patients ≥ 65 years old (yield 7.7%). Abnormal neurologic findings, age ≥ 65 years, trauma, warfarin use, and seizure/stroke history were identified as risk factors. The quality of all articles referenced was strong.Conclusion: More than half of patients with syncope underwent CT head with a diagnostic yield of 1.1% to 3.8%. A future large prospective study is needed to develop a robust risk tool. S yncope is defined as a sudden and brief loss of consciousness (LOC) due to transient global cerebral hypoperfusion, followed by spontaneous and complete recovery. 1 It accounts for 1% to 3% of emergency department (ED) visits. 1-4 Among ED patients with syncope, 7% to 23% will have serious underlying conditions identified either in the ED or within 30 days of their index visit. 5-8 Previous studies have reported 2.3% to 4.4% incidence of serious intracranial conditions (subarachnoid hemorrhage, subdural hematoma, space-occupying lesion, or intraparenchymal infarct or hemorrhage) among

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Section: Discussionmentioning

confidence: 81%

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review

Viau

Chaudry

Hannigan

et al. 2019

Academic Emergency Medicine

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“…In Montreal, Canada, occupational therapists working in acute care are routinely asked to perform early assessment of patients’ rehabilitation potential (RP) and to participate in the referral process to rehabilitation. Rehabilitation professionals’ involvement in early screening of ABI patients’ rehabilitation needs has been advocated in clinical practice guidelines worldwide (ABIKUS Guideline Development Group, ; Casaubon et al ., ; Government of South Australia, ; National Stroke Foundation, ; Schwamm et al ., ). However, to our knowledge, no studies have yet examined occupational therapists’ role in the process of early assessment of RP.…”

Section: Introductionmentioning

confidence: 99%

Exploring factors influencing occupational therapists’ perception of patients’ rehabilitation potential after acquired brain injury

Shun

Bottari

Ogourtsova

et al. 2016

Aus Occup Therapy J

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“…Speech and language rehabilitation should ideally start at the time of acute hospitalization [8]. Unfortunately, in Canada, access to speech and language therapy is often delayed due to unavailability of timely rehabilitation services: in 2014, only 16% of Canadians with stroke were able to access in-patient rehabilitation, and of those, only 50% accessed rehabilitation centers within two weeks of their stroke [9].…”

Section: Introductionmentioning

confidence: 99%

RecoverNow: Feasibility of a Mobile Tablet-Based Rehabilitation Intervention to Treat Post-Stroke Communication Deficits in the Acute Care Setting

et al. 2016

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BackgroundApproximately 40% of patients diagnosed with stroke experience some degree of aphasia. With limited health care resources, patients’ access to speech and language therapies is often delayed. We propose using mobile-platform technology to initiate early speech-language therapy in the acute care setting. For this pilot, our objective was to assess the feasibility of a tablet-based speech-language therapy for patients with communication deficits following acute stroke.MethodsWe enrolled consecutive patients admitted with a stroke and communication deficits with NIHSS score ≥1 on the best language and/or dysarthria parameters. We excluded patients with severe comprehension deficits where communication was not possible. Following baseline assessment by a speech-language pathologist (SLP), patients were provided with a mobile tablet programmed with individualized therapy applications based on the assessment, and instructed to use it for at least one hour per day. Our objective was to establish feasibility by measuring recruitment rate, adherence rate, retention rate, protocol deviations and acceptability.ResultsOver 6 months, 143 patients were admitted with a new diagnosis of stroke: 73 had communication deficits, 44 met inclusion criteria, and 30 were enrolled into RecoverNow (median age 62, 26.6% female) for a recruitment rate of 68% of eligible participants. Participants received mobile tablets at a mean 6.8 days from admission [SEM 1.6], and used them for a mean 149.8 minutes/day [SEM 19.1]. In-hospital retention rate was 97%, and 96% of patients scored the mobile tablet-based communication therapy as at least moderately convenient 3/5 or better with 5/5 being most “convenient”.ConclusionsIndividualized speech-language therapy delivered by mobile tablet technology is feasible in acute care.

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Canadian Stroke Best Practice Recommendations: Acute Inpatient Stroke Care Guidelines, Update 2015

Cited by 65 publications

References 20 publications

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review

The Yield of Computed Tomography of the Head Among Patients Presenting With Syncope: A Systematic Review

Exploring factors influencing occupational therapists’ perception of patients’ rehabilitation potential after acquired brain injury

RecoverNow: Feasibility of a Mobile Tablet-Based Rehabilitation Intervention to Treat Post-Stroke Communication Deficits in the Acute Care Setting

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