Worse endovascular mechanical recanalization results for patients with in-hospital onset acute ischemic stroke

Mönch, Sebastian; Lehm, Manuel; Maegerlein, Christian; Hedderich, Dennis M.; Berndt, Maria; Boeckh‐Behrens, Tobias; Wunderlich, Silke; Kreiser, Kornelia; Zimmer, Claus; Friedrich, Benjamin

doi:10.1007/s00415-018-9035-0

Cited by 13 publications

(15 citation statements)

References 19 publications

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“…6 Overall, patients with in-hospital stroke experience less improvement within 24 hours, show less improvement by discharge, are less likely to be able to ambulate independently on discharge, and are less likely to return directly home. 2,3,5,6,23,49 Analysis of the Get With The Guidelines and South London stroke registries showed that patients with in-hospital stroke were more likely to die in the hospital, and the South London registry reported a higher 5-year mortality for patients with inhospital stroke compared with patients with communityonset stroke. 10,50…”

Section: Discussionmentioning

confidence: 99%

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

Nouh¹,

Amin‐Hanjani²,

Furie³

et al. 2022

Stroke

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This scientific statement describes a path to optimizing care for patients who experience an in-hospital stroke. Although these patients are in a monitored environment, their evaluation and treatment are often delayed compared with patients presenting to the emergency department, contributing to higher rates of morbidity and mortality. Reducing delays and optimizing treatment for patients with in-hospital stroke could improve outcomes. This scientific statement calls for the development of hospital systems of care and targeted quality improvement for in-hospital stroke. We propose 5 core elements to optimize in-hospital stroke care: 1. Deliver stroke training to all hospital staff, including how to activate in-hospital stroke alerts. 2. Create rapid response teams with dedicated stroke training and immediate access to neurological expertise. 3. Standardize the evaluation of patients with potential in-hospital stroke with physical assessment and imaging. 4. Address barriers to treatment potentially, including interfacility transfer to advanced stroke treatment. 5. Establish an in-hospital stroke quality oversight program delivering data-driven performance feedback and driving targeted quality improvement efforts. Additional research is needed to better understand how to reduce the incidence, morbidity, and mortality of in-hospital stroke.

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Section: Discussionmentioning

confidence: 99%

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

Nouh¹,

Amin‐Hanjani²,

Furie³

et al. 2022

Stroke

View full text Add to dashboard Cite

show abstract

“…Previous study showed that patients with in-hospital stroke who were treated with thrombolytics had higher rates of in-hospital mortality and post-thrombolytic intracerebral hemorrhage [8]. Also, patients with in-hospital stroke may have worse recanalization results and poorer clinical outcomes [9]. However, our case showed that mechanical thrombectomy seems safe for treatment of in-hospital strokes.…”

Section: Discussion/conclusionmentioning

confidence: 61%

In-Hospital Mechanical Thrombectomy: A Case Report

Lee

2020

Case Rep Neurol

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We report on a case of a 59-year-old female patient with atrial fibrillation who received edoxaban. She withdrew edoxaban before tooth extraction. She was brought to our emergency department due to acute onset of left-side weakness. Under the impression of acute ischemic stroke, edoxaban was replaced with aspirin. However, the patient suffered from recurrent cerebral embolism with conscious disturbance. Urgent mechanical thrombectomy was performed due to left internal carotid artery occlusion. Remarkable recovery was noted on the second day after thrombectomy. She was discharged with mild neurological deficit. We suggest that early recognition, assessment, and interventional treatment for patients with in-hospital strokes are favorable for stroke outcome.

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“…Because most inpatient strokes occur in nonneurological departments, these delays are mainly due to either lack of awareness of stroke symptoms and nonspecific clinical features 1–3 . In previous studies, the time intervals between symptoms onset and primary physician notification of symptoms onset/stroke alerts activation occupied over 80% of the intervals delay for IHS patients 7,23 . It is impractical to expect nonneurology medical staff to fully grasp all items of NIHSS.…”

Section: Discussionmentioning

confidence: 99%

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

Qiu¹,

Ke²,

Jia³

et al. 2023

J Comput Assist Tomogr

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Objectives: A large quantity of ischemic stroke events occur in patients hospitalized for non-stroke-related reason. No scale has been developed to identify the large vessel occlusion (LVO) among inpatient stroke alerts. We aimed to develop a novel evaluation scale to predict LVO from in-hospital stroke alerts.Methods: Data from consecutive in-hospital stroke alerts were analyzed at a single high volume stroke center between January 2016 and October 2020. We developed a predictive scale based on the first half of patients (training group) using multivariate logistic regression and evaluated it in the remaining half of patients (validation group) adopting receiver operating curve. Receiver operating characteristics of the scale were analyzed to evaluate its value for the detection of LVO.Results: A total of 243 patients were enrolled for further study, among them, 94 (38.7%) had confirmed LVO. Three risk factors independently predicted the presence of LVO: recent cardiac or pulmonary procedure (1 point), neurological deficit scale (≥1: 2 points), and history of atrial fibrillation (1 point). The CAPS scale was generated based on predictive factors and demonstrated highly effective discrimination in identifying the presence of LVO in the training group (area under curve = 0.956) and the validation group (area under curve = 0.940). When the score ≥2, CAPS scale showed 97.9% sensitivity, 79.2% specificity, 74.8% positive predictive value, and 98.3% negative predictive value for discriminating LVO.Conclusions: CAPS scale was developed for identifying LVO among inpatient stroke alerts with high sensitivity and specificity, which may help to quickly prompt responses by appropriate stroke teams.

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Worse endovascular mechanical recanalization results for patients with in-hospital onset acute ischemic stroke

Cited by 13 publications

References 19 publications

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: A Scientific Statement From the American Heart Association

In-Hospital Mechanical Thrombectomy: A Case Report

Design and Validation of a Novel Evaluation Scale to Predict Inpatient Large Vessel Occlusion Strokes: Clinical Assessment Stroke Severity for Inpatient Scale

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