Strokes occurring in the hospital: Symptom recognition and eligibility for treatment in the intensive care units versus hospital wards

Abstract

BACKGROUND: Studies have shown that 4%–17% of acute ischemic strokes (AISs) occur in patients hospitalized for another reason; scanty data are available about the care delivery and outcome of this patient population. MATERIALS AND METHODS: All consecutive inhospital AISs over a 10-year period at our comprehensive stroke center were included in the study. We compared the meantime from last known neurologically intact to symptom detection and also eligibility for acute treatment of patients based on their physical location in the hospital with respect to the level of care when they were found to have the stroke symptoms. RESULTS: Fifty-three patients suffered inhospital AIS during this period (28 in intensive care units/emergency department [ICUs/ED] vs. 25 in regular floors). Only in four patients (7.5%), initial brain imaging was done within 25 min from symptom recognition (as recommended by the American Heart Association/American Society of Anesthesiologists guidelines). Forty-two (79%) underwent brain imaging within 6 h of symptom recognition; of them, 11 (26%) received intravenous thrombolysis (IVT) within the first 4.5 h of symptom onset and 7 (17%) underwent endovascular treatment (EVT). The mean (±standard deviation) time in minutes from last known neurologically intact to symptom detection for floor patients was significantly longer compared to the ICU/ED patients (194 [±149] vs. 74 [±45], P = 0.0003). Patients admitted to the ICU/ED had more chance of being recognized earlier and being eligible for IVT or/and EVT compared to the patients admitted to the regular floors (44% vs. 25%, P = 0.14); however, the difference did not reach statistical significance. CONCLUSIONS: ICU/ED patients had a significantly shorter time to stroke symptom detection from last known neurologically intact when compared to the regular floor patients. Furthermore, they had a trend toward a higher likelihood of being eligible for acute treatment compared to the regular floors, although the result did not reach statistical significance.

Triage Nurse-Activated Emergency Evaluation Reduced Door-to-Needle Time in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…The successful implementation of nurse-activated emergency evaluation depends on experienced triage nurses and suitable tools in stroke recognition. The lack of knowledge and ability of triage nurses were one of the critical factors for the delay in the treatment of stroke patients [ 29 ]. It is crucial for a qualified triage nurse to have the clinical acumen and recognition of complicated conditions, strong organization skills, and proficient management and coordination abilities.…”

Neurologic Complications of Critical Medical Illness

“…15 Delays in stroke recognition are common in the setting of mechanical ventilation, sedation, concomitant metabolic insults, and nursing staff turnover. 12,16 Patients with altered mental status should be carefully examined for supportive signs of stroke, and a last known normal time should be established if possible. Of course, focal findings in critically ill patients may be caused by etiologies other than cerebrovascular disease.…”

“…Opportunities for reperfusion therapy are often missed in hospitalized patients and perhaps even more so in critically ill patients 15 . Delays in stroke recognition are common in the setting of mechanical ventilation, sedation, concomitant metabolic insults, and nursing staff turnover 12,16 . Patients with altered mental status should be carefully examined for supportive signs of stroke, and a last known normal time should be established if possible.…”

MIC19 Exerts Neuroprotective Role via Maintaining the Mitochondrial Structure in a Rat Model of Intracerebral Hemorrhage

“…It can cause serious financial and psychological burdens for ICH patients' families [1,2]. ICH generally emerges as a rapid expansion of hematoma in the brain tissues which may expand into the ventricular system and subarachnoid spaces [3,4]. Despite recent progress in clinical therapy, clinical outcomes of ICH patients still remain unsatisfactory owing to primary and secondary brain injury [5][6][7].…”