An Evaluation Of Time To Review And Brain Imaging Of Inpatient Strokes: Are We Too Slow When Patients Are FAST?

Abstract

Abstract Background Evidence shows that in-patient strokes are more difficult to recognise and treat, often leading to poorer outcomes. There is a recognised delay from symptom onset to stroke alert. 1 The most recent stroke guidelines recommend a time from recognition to imaging of <1hour for acute stroke. Methods We used the stroke database in our centre to identify our acute inpatient strokes over a one-year period from January 2023 to January 2024. The number of patients included was 9. We looked at time from first documented recognition of symptoms to medical review. We also looked at time from review to brain imaging. This information was collected using our database which records time-of-onset of symptoms and our local imaging system. Results Of the 9 patients identified 5 had symptoms recognised and documented by ward staff prior to medical review. The average time from recognition of symptoms to review was 2 hours and 26 mins. The shortest time to review was 35 mins and the longest was 8 hrs and 45 mins. For the remaining 4 patients, the first documentation of symptoms was the initial medical review. Three patients had initial brain imaging in under 1hour. One patient had brain imaging within 75 minutes. The remaining 5 patients waited between 5 and 7 hours for initial imaging. Conclusion Of the 9 acute inpatient strokes identified, average time to review from onset of symptoms was 2 hours and 26 mins. Thirty percent (N=3) received initial brain imaging within 1hour. These results highlight the significant challenge of inpatient stroke management as described in the literature. 1 One intervention identified is the introduction of a stroke alert bleep. After the introduction of this measure, we hope to re-evaluate our times. Reference 1. Identifying Best Practices to Improve Evaluation and Management of In-Hospital Stroke: From the American Heart Association. https://www.ahajournals.org/doi/10.1161/STR.0000000000000402.