Abstract WP281: Post-tPA Care for Acute Stroke Patients; Comparison between Intensive Care Unit Admission and Stroke Unit Admission.

Abstract

Backgound: The American Stroke Association guidelines for acute stroke indicate that patients receiving tPA can be admitted to an ICU or a stroke unit (SU). Admission to a SU could result in cost savings and better resource allocation. We sought to compare a strategy of admitting all tPA-treated stroke patients to the ICU vs. admitting them to a SU. Material and Methods: Retrospective observational study. During the initial 3 years of the study all tPA patients were admitted to the ICU as we lacked a SU. In the following 2 years, patients were admitted to a new SU. We obtained baseline demographics, past medical history, admission NIHSS, treatment interventions, neurologic and medical complications, and mortality for both groups to determine if ICU admission resulted in better outcome and less complications than SU admission. Fishers exact test was used for categorical variables and proportion of the means test (t-test) for continuous variables. Results: A total of 71 patients were admitted to the ICU and 104 were admitted to the SU. ICU admission included 54% males and SU admission included 59% males (NS). The median age for ICU and SU admission was 69 and 70 respectively (NS). The admission NIHSS was 11 for ICU patients and 9 for SU patients (NS). The median length of stay in the ICU was 1 day (as per protocol) and the median SU length of stay was 4 days. Intravenous hypertensives (bolus) were used in 30% of ICU patients and in 18% of SU patients (p= 0.09) and continuous infusions were required in 11% of ICU patients and 6% of SU patients (p=0.04). Initial NIHSS scale of > 15 predicted need for mechanical ventilation and ICU admission (p=0.002). Intracranial hemorrhage occurred in 3% of ICU and 3% of SU patients (NS). There was no difference in medical complications (pneumonia, venous thromboembolism, sepsis, or death) in the 2 groups. There was no significant difference in the proportion of patients with excellent outcome (mRS of 1 or less) in the two groups (38% vs 36%). Stroke unit admission saves $70,000 per 100 patients per day. Conclusions: Stroke patients receiving intravenous tPA can be safely admitted to a SU resulting in significant savings. Patients with NIHSS > 15 are likely to need ICU admission for mechanical ventilation.