Strokes occurring in the hospital: Symptom recognition and eligibility for treatment in the intensive care units versus hospital wards
Haris Kamal1, Muhammad K Ahmed1, Alicia Zha1, Navdeep S Lail2, Peyman Shirani3, Robert N Sawyer2, Ashkan Mowla4
1 Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, Texas, USA
2 Department of Neurology, University at Buffalo, State University of New York, Buffalo, New York, USA
3 Department of Neurology and Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
4 Department of Neurological Surgery, Division of Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Department of Neurological Surgery, Division of Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, 1200 North State Street, Suite 3300, Los Angeles 90033, CA
Source of Support: None, Conflict of Interest: None
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.