Delays in the Identification and Assessment of in-Hospital Stroke Patients

Don't have a stroke while in the hospital. Has your hospital addressed this problem in the last 5 years?

This was known way back in December 2016; what EXACTLY has your hospital done to solve this?

If they haven't solved this you better not have a stroke while hospitalized for COVID-19.

Diane and Bob had a similar problem within the hospital. 

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

December 2016 

The latest here:

Delays in the Identification and Assessment of in-Hospital Stroke Patients

• Stephanie Cummings
• Scott E. Kasner
• Michael Mullen
• 
  
• Nimesh Desai
• Michael Acker
• Steven R. Messé
• Show all authors

Published:February 03, 2022DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106327

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Highlights

• •
  In-hospital strokes are severe and are often periprocedural.
• •
  In-hospital strokes are associated with long delays from last known normal to symptom detection and from symptom detection to stroke team alerting.
• •
  Delays are strongly associated with intubation, and protocols should be used to allow for rapid anesthesia offset after procedures and intermittent lightening of sedation for more frequent and reliable neuro assessments.
• •
  Large vessel occlusion is common, yet many patients were not able to receive an intervention, likely due to delays.

Abstract

Objectives

In-hospital stroke is associated with poor outcomes. Reasons for delays, use of interventions, and presence of large vessel occlusion are not well characterized.

Materials and methods

A retrospective single center cohort of 97 patients with in-hospital stroke was analyzed to identify factors associated with delays from last known normal to symptom identification and to stroke team alerting. Stroke interventions and presence of large vessel occlusion were also assessed.

Results

Strokes were predominantly on surgery services (70%), ischemic (82%), and severe (median NIHSS 16; interquartile range [IQR] 6-24). There were long delays from last known normal to symptom identification (median 5.1 hours, IQR 1.0-19.7 hours), symptom identification to stroke team alerting (median 2.1 hours, IQR 0.5-9.9 hours), and total time from last known normal to alerting (median 11.4 [IQR 2.7-34.2] hours). In univariable analysis, being on a surgical service, in an ICU, intubated, and higher NIHSS were associated with delays. In multivariable analysis only intubation was independently associated with time from last known normal to symptom identification (coefficient 20 hours, IQR 0.2 – 39.8, p=0.047). Interventions were given to 17/80 (21%) ischemic stroke patients; 3 (4%) received IV tPA and 14 (18%) underwent thrombectomy. Vascular imaging occurred in 57/80 (71%) ischemic stroke patients and 21/57 (37%) had large vessel occlusion.

Conclusions

Hospitalized patients with stroke experience long delays from symptom identification to stroke team alerting. Intubation was strongly associated with delay to symptom identification. Although stroke severity was high and large vessel occlusion common, many patients did not receive acute interventions.

Key Words

• Stroke
• In-hospital stroke
• Acute stroke intervention
• Large vessel occlusion

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