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Ischemic Stroke
Original research
An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time
  1. Jody Manners1,
  2. Namir Khandker2,
  3. Adam Barron1,
  4. Yasmin Aziz1,
  5. Shashvat M Desai1,
  6. Benjamin Morrow3,
  7. William T Delfyett4,
  8. Christian Martin-Gill5,
  9. Lori Shutter2,
  10. Tudor G Jovin1,
  11. Ashutosh P Jadhav1
  1. 1 Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2 Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  3. 3 Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  4. 4 Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  5. 5 Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  1. Correspondence to Dr Ashutosh P Jadhav, Neurology, University of Pittsburgh, Pittsburgh, PA 15260, USA; jadhavap{at}upmc.edu

Abstract

Background Inhospital stroke (IHS) is associated with high morbidity and mortality, likely related to multiple factors, including delayed time to recognition, associated comorbidities, and initial care from non-stroke trained providers. We hypothesized that guided revision of a formalized ‘stroke code’ system can improve diagnosis and time to thrombolysis and thrombectomy.

Methods IHS activations occurring at a comprehensive stroke center between 2013 and 2016 were retrospectively analyzed to guide revisions of an established stroke code protocol to improve provider communication and time to imaging, reduce stroke mimic rate, and improve the use of parallel processing. After protocol implementation, we prospectively collected data between 2016 and 2017 for comparison with the pre-implementation group, including diagnostic accuracy and relevant time points (code call to examination, examination to imaging, and imaging to intervention). We report descriptive statistics for comparison of patient characteristics and time metrics (time to imaging and reperfusion after IHS activation). Multivariable regression analysis was performed to identify independent predictors of stroke mimics and time metrics.

Results There were 136 cases in the pre-implementation group and 69 in the post-implementation group. A reduction in stroke mimics (52% vs 33%, P=0.01) occurred after protocol initiation. Mean time to imaging after stroke code call was 7.6 min shorter (P=0.026) and mean time from imaging to acute reperfusion therapy was 45.7 vs 19.8 min (P=0.05) in the pre- versus the post-implementation group.

Conclusion Revision of an existing IHS protocol was associated with a lower rate of stroke mimics, and a shorter time to intravenous and intra-arterial intervention.

  • stroke
  • thrombectomy
  • thrombolysis

https://doi.org/10.1136/neurintsurg-2019-014890

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    Footnotes

    • Contributors All authors listed contributed to our project as follows: JM: author design and conceptualization, acquisition of the data, analysis and interpretation of the data, and manuscript draft. NK: acquisition of the data, analysis and interpretation of the data, and revising of the article. AB: acquisition of the data, analysis and interpretation of the data, and revising of the article. YA: acquisition of the data, analysis and interpretation of the data, and revising of article. SMD: acquisition of the data, analysis and interpretation of the data, statistical analysis, and revising of the article. BM: acquisition of the data, analysis and interpretation of the data, statistical analysis, and revising of the article. WTD: acquisition of the data, analysis and interpretation of the data, and revising of the article. CM-G: acquisition of the data, analysis and interpretation of the data, and revising of article. LS: acquisition of the data, analysis and interpretation of the data, and revising of the article. TGJ: acquisition of the data, analysis and interpretation of the data, and revising of the article. APJ: design and conceptualization, acquisition of the data, analysis and interpretation of the data, and study supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval Institutional review board approval was obtained prior to data collection, and all measures were supported by stakeholders and approved through a local quality improvement committee prior to initiation of the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.