Abstract 58: Do Ischemic Stroke Patients Treated With Thrombolysis Receive Better Quality Multidisciplinary Stroke Care Than Patients Who Do Not?

Abstract

Background: Over recent years many stroke services have developed fast track services for stroke thrombolysis. We aimed to identity if such hyperacute provision also improved other aspects of multidisciplinary care by comparison to non-thrombolysed patients. Methods: Data were extracted from the national stroke register (Sentinel Stroke National Audit Programme (SSNAP)) of adults with acute ischemic stroke admitted to all hospitals in England and Wales from April 2013-March 2014. The quality of care received was compared across three groups: patients treated with IV-tPA, patients arriving at hospital within a 4h time window of onset but who were not treated with tPA, and patients who arrived outside the 4h time window and who were not treated with tPA. Results: Of 65 194 adults admitted with acute ischemic stroke to 194 hospitals, 8 602 (13.2%) were treated with tPA, 20 361 (31.2%) arrived within 4h of onset but were not treated with tPA, and 36 231 (55.6%) arrived outside the time window. A greater proportion of patients treated with tPA were admitted to a stroke unit within 4 hours of hospital arrival (85%) compared to those within the time window but not treated with tPA (57%) or those outside the time window (54%), Chi2 p<0.0001. A similar pattern was observed for being seen by a stroke consultant within 24 hours (92%, 72%, 72% respectively, Chi2 p<0.0001), and for the proportion of patients scanned within 12 hours (100%, 87%, 81% respectively, Chi2 p<0.0001). tPA recipients were more likely to receive a swallow assessment within 4h (83%, 64%, 60%, p<0.0001), and to be assessed by speech and language therapists with 72h (85%, 77%, 78%, p<0.0001). Smaller differences were found for occupational therapy (91%, 85%, 86%, p<0.0001) and physiotherapy assessments within 72h (97%, 93%, 94%, p<0.0001). Conclusions: Patients treated with tPA receive faster access to specialist stroke services, and were more likely to receive various aspects of multidisciplinary stroke care. Stroke services should ensure that all patients have rapid access to good quality multidisciplinary stroke care, not just those in receipt of thrombolysis.