Abstract T MP55: Implementation of an Emergency Department Stroke Unit Improves Clinical Outcomes for Acute Ischemic Stroke Due to Shorter Times to Treatment

Abstract

Introduction: The benefits of IV TPA and endovascular AIS therapy (EVT) have been demonstrated to be time dependent. We hypothesized that a stroke unit embedded in the emergency department (ED) would provide more efficient delivery of acute ischemic stroke (AIS) therapy and result in improved clinical outcomes. Methods: Retrospective chart review was performed of the University of Tennessee Health Science Center prospective database of AIS from January 2011 to December 2012 to identify patients treated with IV TPA with or without EVT. The ED stroke unit (EDSU) is run by nurses trained to clinical competencies of our institution’s neurocritical unit. EDSU nurses are only assigned two patients within the unit. Baseline characteristics and details of treatment were abstracted for patients treated in the EDSU and general ED population. Univariate analysis was performed with Chi Square and Student's T-tests. Stepwise multivariate regression analysis (sMVR) was performed to compare characteristics and outcome of patients treated in the two ED locations. Results: A total of 160 patients were treated with IV TPA during the study period with 70 treated in the EDSU. Thirty-three patients also received EVT. The average age was 62.2 and mean NIHSS was 10.8. Univariate analysis demonstrated that cocaine use (8.4% vs. 0.0, p=0.02) and smoking (73% vs. 30%, p=0.01) were more common in the ED population while previous stroke (59.0% vs. 21.6%p=0.006) was significantly more frequent in the EDSU group. NIHSS at presentation and discharge were lower in the EDSU (9.4 vs. 12.0, p = 0.006 and 4.3 vs. 6.1, p=0.03). Door-to-needle (DTN) for IV TPA and door to arterial puncture (DAP) for EVT were both significantly shorter in the EDSU (58.7 vs. 74.9 minutes, p=0.0002 and 101 vs. 155, p=0.003). sMVR confirmed that patients in the EDSU had significantly shorter DTN for IV TPA (p=0.0005) and DAP for EVT (p=0.02). sMVR also demonstrated that improved outcome was due to significantly shorter IV TPA DTN time (p=0.04) regardless of location. Conclusion: The implementation of an EDSU improved the delivery of time sensitive acute ischemic stroke therapies resulting in improved outcomes. This study supports the investment of resources in ED systems of care specifically tailored to AIS.