Abstract W P228: Results Of A Turkish Comprehensive Stroke Center Quality Program. A median Of Door To Needle Time Of 60 Minutes Is Achievable With MRI Based Diagnostic Paradigm

Abstract

BACKGROUND: Quality measures provide the basis for evaluating and improving treatment of stroke patients based on scientific evidence. In this study, the first year results of a quality program of acute ischemic stroke patients who were admitted within the first 24 hours after the onset in a Turkish comprehensive stroke center were reviewed. METHODS: Between September 2012 and August 2013, 161 patients were consecutively admitted to Memorial Stroke Center; they were mainly diagnosed with MRI. Institutional quality program, which include Joint Commission International primary and comprehensive stroke center quality indicators, is maintained prospectively and the threshold values of performance were defined as 80% and above. RESULTS: Fifty three percent of the cases were male and the mean age was 68. Median onset to door time was 233 minutes. Median door to imaging time for the patients admitted within 4.5 hours was 15 minutes. Median imaging duration was 25 minutes. Median and mean door to end of imaging was 40 and 43 minutes respectively. Forty patients underwent acute revascularization therapy; 23 only IV r-TPA, 10 bridging, 7 only endovascular therapy. From eligible patients, 88,9% received IV thrombolysis and 78.9% received endovascular treatment within appropriate time window. The median door to needle time was 65 minutes both for patients in the 4,5 and 6 hours from onset. Only 25% percent of patients receiving IV r-TPA were treated within 40 minutes after arrival. The median door to the groin puncture and groin puncture to recanalization time were 84 and 105 min respectively. There was no symptomatic bleeding in revascularized patients. The percent of good prognosis (mRS 0-2) and mortality was 62,5% and 8,8% respectively. DISCUSSION: Results of our quality data are in line with the literature despite use of an MR-based diagnostic paradigm. Only 1 of 4 patients received thrombolysis within 40 minutes, but this is mainly due to treatment decisional and starting process after the end of imaging, which should and can be shortened.