Abstract 132: In-hospital Versus Out-of-hospital Code Stroke: Iv Tpa Rate And Clinical Outcomes.

Abstract

Background: Patients with Code Stroke alert in the hospital may have different risk factors, demographics and differential diagnoses than patients who are admitted with Code Stroke Alert to the ED. Hospitals and health care systems use considerable resources to provide 24/7 acute stroke care access to in-hospital Code Stroke alerts. Most of the utility analyses are based on data from out-of-hospital stroke. We analyzed the frequency of IV tPA use and the likelihood of home discharge in patients with Code Stroke alert in the hospital versus out-of-hospital. Methods: All adult patients with Code Stroke alerts in the UCSD SPOTRIAS Database from 2004 to 2011, excluding patients transferred from acute care facilities; grouped into 1: out-of-hospital Code Stroke alerts (EMS or ED) and 2: in-hospital (all inpatient units) and analyzed by baseline demographics; time to treatment decision; frequency of IV tPA use; diagnosis (Acute Ischemic Stroke, SAH, ICH, TIA, mimic, unknown); discharge disposition (home versus other), 90 day modified Rankin Scale (mRS) and adjusted for multiple co-variables. Results: We identified 2,699 Code Stroke alerts; 2,498 in group 1 and 201 in group 2. Patients in group 2 were younger (63.6±15.5 vs 66.8±16.8 years of age, p=0.005), more likely to have diabetes (27.9 vs 21.3%, p=0.03), had higher baseline NIHSS (11.6±11.6 vs 9.0±10.0, 0.007) and likelihood to have a pre-stroke mRS >1 (35.8 vs 27.4%, p=0.01); had fewer acute ischemic strokes (38.8 vs 46.6%), but more stroke mimics (39.8 vs 29.5%), p=0.01,had shorter time from stroke onset to treatment decision (202.2±282.3 vs 275.2±423.1 min, p<0.0001) and were less likely to receive IV tPA (10.0 vs 16.0%, p=0.03). The time from onset to IV tPA treatment in Group 2 was 162.9±69.8 min; vs 150.1±106.0, p=0.07. Multivariable logistic regression analysis adjusting for age, history of diabetes and admission NIHSS show that the rates of being discharge home (OR=0.83, 95%CI = 0.59, 1.17, p=0.29) and having a 90-day mRS of 0-1 (OR-1.35, 95% CI = 0.64, 2.86), p=0.44) are similar in the two groups. Conclusion: In-hospital are less likely to lead to IV tPA treatment than out-of-hospital Code Stroke alerts. Patient outcome based on discharge disposition and 90-day mRS is not significantly different from out-of-hospital Code Stroke.