Evaluation of adult stroke presentations at an Emergency Department in Queensland Australia

Abstract

Background:Stroke is a leading cause of mortality and morbidity which places high demands on emergency departments(EDs). Currently there is limited data on stroke presentations to Australian EDs and the time performance management of these presentations. Therefore, the aim of this study was to evaluate stroke presentations at an ED in Queensland, Australia in terms of demographics and time performance measures over a five year period.Methods:Retrospective analysis of ED presentations by patients≥18 years with a final diagnosis of stroke between 1 July 2010 and 30 June 2015.Results:Over the five years there was a 51.4% increase in presentations diagnosed with stroke. The majority of these patients arrived by ambulance(71.0%) and were admitted(94.9%) with death in ED for 1.4% of presentations. From 2010 to 2015 for both haemorrhagic and ischaemic stroke there was a significant decrease in median LOS in ED(435 to 215 mins,p<0.05 and 451 to 238 mins,p<0.001 respectively) and in the proportion of patients in ED greater than four hours(82.4% to 44%,p<0.05 and 92.4% to 45.8%,p<0.0001 respectively). Conclusion:Despite increased presentations of stroke, the ED improved in multiple time performance measures. Improving time-based targets in ED is particularly important for stroke presentations given the time critical nature of stroke management. An observational study was conducted at a public teaching hospital in South-East Queensland. The ED recorded 91902 total ED presentations in 2014-5[11]. Human Research Ethics Committee approval was obtained from the local health service and Griffith University (HREC/14/QPAH/445 and GU 2015/863) Data source Data were extracted by a member of the hospital Health Informatics Division. This pertained to routinely collected data from the hospital information systems including Emergency Department Information System (EDIS), Hospital Based Corporate Information System (HBCIS) and the PPM/TII database. Data extracted included demographics, i.e. date of birth and gender, and clinical information, i.e. arrival date and time, mode of arrival, triage priority, date and time seen by treating doctor, departure date and time, departure status, and ED length of stay (LOS) with times represented in minutes.

Scoping review of molecular biomarkers associated with fatigue, stress, and depression in stroke survivors: A protocol

“…Stroke is one of the five leading causes of death in Australia [1], and the burden resulting from stroke has increased globally [2]. While more people survive stroke due to medical interventions [3], between 25%-74% of stroke survivors experience ongoing psychological comorbidities [4][5][6][7]. These comorbidities include symptoms of stress in 68% of patients, anxiety in 52.9% of patients, and depression in 74.5% of patients [6,8].…”

Evaluating Stroke Code Activation Pathway in Emergency Departments study

“…3,4 As reperfusion outcomes are time-dependent, timely access to stroke care remains challenging. 5,6 Stroke systems have evolved over the past two decades in an effort to improve access to early stroke assessment and management. Such systems include prehospital notification and in select cases early reperfusion.…”

“…Time‐critical reperfusion therapies in selected patients with acute ischaemic stroke are associated with better outcomes and reduced risk of disability 3,4 . As reperfusion outcomes are time‐dependent, timely access to stroke care remains challenging 5,6 . Stroke systems have evolved over the past two decades in an effort to improve access to early stroke assessment and management.…”

Factors Influencing Pre-Hospital and In-Hospital Delays at Time-To-Treatment and Complications in Stroke: A Prospective Cohort Study

“…In the early hours, AIS is a medical emergency requiring critical treatment and care because auspicious results can be obtained by its fast diagnosis and proper interventions. Furthermore, delayed treatment can lead to considerable complications, higher mortality, and heavy expenses for the person, families, and the community health system (5,6).…”