Abstract TP304: Emergent Therapeutic Interventions Beyond Thrombolysis in Patients Evaluated Through the In-Hospital Stroke Alert Protocol

Abstract

Background: In-Hospital Stroke Alert Protocols (IHSAPs) are designed to evaluate acute thrombolysis candidacy in patients who develop acute ischemic stroke (AIS) while hospitalized for other causes. However, co-existing medical illnesses may result in difficulty in symptom recognition, false positive alerts, and a high number of contraindications to reperfusion therapies. Methods: We analyzed data of all Stroke Alert Protocol cases evaluated by the vascular neurology team in an academic university hospital over 4 consecutive years. Patient demographics and location at the moment of activation were recorded. Clinical presentation, final diagnosis, and acute interventions were compared between inpatients and those presenting to the emergency department (ED). Results: Of 1,965 included cases, 489 (24.9%) Stroke Alerts were activated in already hospitalized patients and 1,476 (75.1%) in the emergency department. IHSAPs cases were more likely to present with non-localizing neurological deficits (46.2 % vs. 32.4%, p<0.0001) and diagnosed with non-cerebrovascular disorders (62.4% vs. 47.5%, p<0.0001). Critical acute therapeutic interventions other than thrombolysis were delivered in 377 (77.1%) cases evaluated through the IHSAP. When compared to the ED, inpatients were more commonly managed with correction of metabolic abnormalities (21.5% vs. 13.7%, p<0.0001), suspension or pharmacological reversal of drugs (11% vs. 3.7%, p<0.0001), and initiation of respiratory support (13.5% vs. 9.3%, p=0.01). Inpatients diagnosed with AIS received intravenous thrombolysis less frequently (4.9% vs. 23.9%, p<0.0001), but the proportion of endovascular treatments was similar to those presenting to the ED (9.8% vs. 10.3%). Conclusion: Patients who developed in-hospital ischemic stroke rarely received intravenous thrombolysis, however, the rate of endovascular treatment was similar to those presenting from the community to the ED. The vascular neurology team commonly implemented emergent time-sensitive therapeutic interventions other than thrombolysis during the evaluation of inpatients with stroke-like symptoms.