Recognition Of Stroke Symptoms Research Articles

Addressing Disparities in Acute Stroke Management and Prognosis.

There are now abundant data demonstrating disparities in acute stroke management and prognosis; however, interventions to reduce these disparities remain limited. This special report aims to provide a critical review of the current landscape of disparities in acute stroke care and highlight opportunities to use implementation science to reduce disparities throughout the early care continuum. In the prehospital setting, stroke symptom recognition campaigns that have been successful in reducing prehospital delays used a multilevel approach to education, including mass media, culturally tailored community education, and professional education. The mobile stroke unit is an organizational intervention that has the potential to provide more equitable access to timely thrombolysis and thrombectomy treatments. In the hospital setting, interventions to address implicit biases among health care providers in acute stroke care decision-making are urgently needed as part of a multifaceted approach to advance stroke equity. Implementing stroke systems of care interventions, such as evidence-based stroke care protocols at designated stroke centers, can have a broader public health impact and may help reduce geographic, racial, and ethnic disparities in stroke care, although further research is needed. The long-term impact of disparities in acute stroke care cannot be underestimated. The consistent trend of longer time to treatment for Black and Hispanic people experiencing stroke has direct implications on long-term disability and independence after stroke. A learning health system model may help expedite the translation of evidence-based interventions into clinical practice to reduce disparities in stroke care.

Mnemonic utilization in stroke education: FAST and BEFAST adoption by certified comprehensive stroke centers.

Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face-Arm-Speech-Time) and BEFAST (Balance-Eyes-Face-Arm Speech-Time). The FAST mnemonic can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). We sought to analyze the pattern of public educational materials available on the websites of US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country's 217 JC-certified CSCs, which was downloaded in August, 2022. Each CSC's website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. The FAST mnemonic was listed by 35% of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Consistency is critical in shaping public health education related to stroke symptoms recognition. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

A stroke prediction framework using explainable ensemble learning

The death of brain cells occurs when blood flow to a particular area of the brain is abruptly cut off, resulting in a stroke. Early recognition of stroke symptoms is essential to prevent strokes and promote a healthy lifestyle. FAST tests (looking for abnormalities in the face, arms, and speech) have limitations in reliability and accuracy for diagnosing strokes. This research employs machine learning (ML) techniques to develop and assess multiple ML models to establish a robust stroke risk prediction framework. This research uses a stacking-based ensemble method to select the best three machine learning (ML) models and combine their collective intelligence. An empirical evaluation of a publicly available stroke prediction dataset demonstrates the superior performance of the proposed stacking-based ensemble model, with only one misclassification. The experimental results reveal that the proposed stacking model surpasses other state-of-the-art research, achieving accuracy, precision, F1-score of 99.99%, recall of 100%, receiver operating characteristics (ROC), Mathews correlation coefficient (MCC), and Kappa scores 1.0. Furthermore, Shapley’s Additive Explanations (SHAP) are employed to analyze the predictions of the black-box machine learning (ML) models. The findings highlight that age, BMI, and glucose level are the most significant risk factors for stroke prediction. These findings contribute to the development of more efficient techniques for stroke prediction, potentially saving many lives.

Abstract WMP25: Implementing a Rapid Response Model to Improve Efficiency of In-Hospital Stroke Code Processes

Introduction: In-hospital stroke (IHS), which occurs during hospitalization for other conditions, presents unique challenges and complexities. Studies have shown IHS is associated with worse patient outcomes, e.g., higher morbidity and mortality, compared to community-onset stroke treated in the emergency department. Time from initial symptom recognition to diagnostic imaging is critical for implementing first line therapy. During IHS, efficient and consistent performance of time-sensitive treatments relies on well-defined roles and parallel processing of tasks. Method: A QI initiative aimed at reducing time from initial stroke symptom recognition to initiation of a non-contrast CT (NCCT) scan was implemented at the start of FY 2022 at our CSC. Focus included broad education of all hospital personnel and their defined role in IHS recognition and care. Program analysis included retrospective and prospective data collected from patients’ electronic health records (EHR) and daily EHR audits for comparison of pre- and post-implementation data (FY 2021 and FY 2022, respectively). Data collection included time of stroke code call (symptom recognition), time of NCCT, and compliance of turn-around-time (TAT) between data points, with a goal of < 20 minutes. Results: An overall increase in the number of IHS code calls between FY 2021 and FY 2022 (n=82 vs. n=106, respectively) was appreciated, with an overall decrease in mean time from stroke recognition to NCCT ( M =22 vs. M =18.3 minutes, respectively). Overall compliance of TAT between these two data points increased from 53% to 73% post QI implementation. Additionally, we experienced an improvement in IHS activation time to IV thrombolytics administration time with a median time of 64.5 minutes (FY 2021, n=8) to median time of 59 minutes (FY 2022). Conclusion: Implementing a system wide QI initiative for IHS with well-defined roles and expectations, and parallel processing of tasks can lead to early recognition and activation of IHS code calls. Improved symptom recognition, code activation, and coordinated response efforts improved time and compliance to initial imaging as well as time to thrombolytic administration in our patient population.

Patient factors associated with treatment time for stroke before and after the onset of COVID-19

ObjectivesPrior to our study, little was known about factors related to time-to-treatment for stroke pre- and post-COVID-19. Design: This was a retrospective cohort study to evaluate factors associated with delayed door-to-needle time among patients with acute ischemic stroke over two time-periods. Results: Final sample consisted of 932 charts with mean age of 68.1(±15.6). Significant factors associated with shorter door-to-needle time included ≤ four hours since symptom onset and stroke occurring during post-Covid-19 time-period. Those on anti-coagulants had 72 % higher odds of longer door-to-needle time. As patients got older and stroke symptoms were more severe, less time was spent in door-to-imaging. Conclusion: Results highlight the importance of early recognition of stroke symptoms and rapid transport to the hospital. Faster response times in post-Covid-19 time-period may be attributable to systematic processes put in place to address pandemic-related challenges. Outcomes may depend on research to identify gaps in stroke treatment.

Evaluation of stroke in pregnant and non-pregnant women of reproductive years: A multicenter ambispective cohort study in a low- to middle-income country.

Early recognition of stroke symptoms and risk factors is important for timely intervention to improve outcomes. This study aimed to investigate differences in stroke frequency, risk factors, and presentation in pregnant and non-pregnant women of reproductive years. This multicenter ambispective cohort study, conducted from 4th August 2021 to 4th March 2023, examined strokes in women of reproductive years at the neurology outpatient/emergency department of five busiest/referred neuro-medical facilities in Karachi, Pakistan, where patients from across the nation are assessed. In all, 1210 patients were enrolled via consecutive or convenient sampling retrospectively from January 2017 to August 2021 and prospectively from August 2021 to March 2023. Pregnancy-related and non-pregnancy-related stroke occurrence and characteristics were compared using the chi-square/Fischer's exact test. 56% were non-pregnancy-related strokes and 44% were pregnancy-related strokes with non-pregnancy-related strokes approximately equal throughout the reproductive years (15-24 years = 34%, 25-34 years = 25%, 35-45 years = 41%) and pregnancy-related stroke between 15 and 35 years (82%). In the non-pregnancy-related stroke, arterial stroke dominated (96.4%); while in pregnancy-related stroke, arterial stroke accounted for 61.4% and venous stroke for 38.6% of cases. Middle cerebral artery was a typical stroke site (66%). Infarction was the most significant CT/MRI finding (PRS = 89%, NPRS = 66%), with pregnancy-related stroke hemorrhagic stroke occurring in only 11% of cases and non-pregnancy-related stroke comprising one-third (34%). The most prevalent etiologies were eclampsia in pregnancy-related stroke (32%), hypertension in non-pregnancy-related stroke (40%), and cardiac problems among both groups (25%:33%). Weakness and headache were the common clinical manifestations among both groups. In the pregnancy-related and non-pregnancy-related stroke groups, the initial presentation of stroke resulted in severe disability for 91% and 75%, respectively. With timely treatment, the outcome improved significantly. The mortality rate was 7% for the pregnancy-related stroke group and 4% for the non-pregnancy-related stroke group. Our findings show that stroke is prevalent among reproductive-year women, posing a significant mortality risk if not adequately recognized and treated. Awareness, research, and screening of stroke risk factors and their often-overlooked early presentation (i.e., headache and weakness) in reproductive years are essential to reducing stroke occurrence among reproductive-year women.

Gap between recognition and response to stroke scenarios among Saudi population: Cross-sectional survey study

ObjectivesRecognition of stroke symptoms and emergency medical services (EMS) calls have a significant impact on patient management and outcome after acute strokes. The objective of this study is to assess the presence of a gap in the Saudi population between the recognition of stroke symptoms and the appropriate response to call EMS. Materials and MethodsThis questionnaire-based, cross-sectional survey study was conducted among the Saudi population with 563 total participants. The data were collected using a self-administered, web-based questionnaire. It was distributed randomly via social media platforms and emails to the general population of Saudi Arabia (SA). A series of 12 vignettes of stroke scenarios and four non-stroke scenarios was adapted from validated instruments. ResultsOur study revealed that 8% (n = 533) of the responses were appropriately recognized and resulted in calls to EMS while 38% (n = 2,639) did not respond by calling EMS despite their correct recognition. However, 9% (n = 608) chose to call EMS regardless of their incorrect recognition of the stroke scenario, and the plurality, 45% (n = 3,096), did not recognize the stroke scenario or respond by calling EMS. Furthermore, we found a statistically significant association among appropriate response, recognition, and self-efficacy. ConclusionsA recognition-response gap has been found among the Saudi population. Future campaigns should focus on the identification of common stroke symptoms and reinforce the importance of calling the EMS to apply the knowledge appropriately. Consequently, such actions could decrease mortality and chronic disability among stroke patients.

Results of an international survey on the status of prehospital care.

Prehospital care including recognition of stroke symptoms by the public and professionals combined with an efficient and effective emergency medical service (EMS) is essential to increase access to effective acute stroke care. We undertook a survey to document the status of stroke prehospital care globally. A survey was distributed via email to the World Stroke Organization (WSO) members. Information was sought on the current status of stroke prehospital delay globally, including (1) ambulance availability and whether payment for use is required, (2) ambulance response times and the proportion of patients arriving at hospital by ambulance, (3) the proportion of patients arriving within 3 h and more than 24 h after symptom, (4) whether stroke care training of paramedics, call handlers, and primary care staff, (5) availability of specialist centers, and (6) the proportion of patients taken to specialist centers. Respondents were also asked to identify the top three changes in prehospital care that would benefit their population. Data were analyzed descriptively at both country and continent level. Responses were received from 116 individuals in 43 countries, with a response rate of 4.7%. Most respondents (90%) reported access to ambulances, but 40% of respondents reported payment was required by the patient. Where an ambulance service was available (105 respondents) 37% of respondents reported that less than 50% of patients used an ambulance and 12% less than 20% of patients used an ambulance. Large variations in ambulance response times were reported both within and between countries. Most of the participating high-income countries (HIC) offered a service used by patients, but this was rarely the case for the low- and middle-income countries (LMIC). Time to admission was often much longer in LMIC, and there was less access to stroke training for EMS and primary care staff. Significant deficiencies in stroke prehospital care exist globally especially in LMIC. In all countries, there are opportunities to improve the quality of the service in ways that would likely result in improved outcomes after acute stroke.

Recurrent stroke arrival time

BackgroundStroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical services (EMS). The impact of this education is unclear. We aimed to measure the associations between EMS use and timing of hospital arrival and first-ever and recurrent strokes as a proxy for stroke education. MethodsThe study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes, 259 instances of recurrent stroke within 1 year of the first (early recurrence), and 451 recurrent strokes over 1 year from the first (late recurrence). Following imputation, associations of both EMS arrival (available starting late 2011) and early arrival (< 3 hours) with first-ever versus recurrent stroke (early and late) were assessed with logistic models, accounting for the clustering of multiple strokes per participant with generalized estimating equations. Full model covariates included stroke type, initial stroke severity, marital status, race/ethnicity, gender, age, insurance, education, and EMS use (early arrival model only). ResultsCompared to first-ever stroke, there were significantly higher unadjusted odds of arrival by EMS for the late recurrence group (late recurrence OR = 1.54, 95% CI = 1.18-1.99; early arrival OR = 1.24, 95% CI = 0.87-1.76). The association for late recurrence remained significant after adjustment (aOR = 1.46, 95% CI = 1.09-1.95). The pre-2010 unadjusted odds of early arrival were non-significant for both early and late recurrence groups (late recurrence OR = 1.05, CI = 0.70-1.56; early recurrence OR = 0.85, CI = 0.54-1.33), while late recurrence was associated with early arrival after 2010 (OR = 1.32, 95% CI = 1.03-1.69). After full adjustment, it was no longer significant (aOR = 1.25, 95% CI = 0.96-1.62). Higher initial stroke severity, married status, and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had borderline significant lower odds of EMS use compared to those who were not. ConclusionsOur study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. Recurrence at least one year after the first stroke was associated with higher EMS usage, but there was not enough evidence to establish a relationship with early arrival after accounting for EMS usage and possible confounders. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.

Abstract Number ‐ 65: US Comprehensive Stroke Center Utilization of FAST and BEFAST Mnemonics for Public Education

Introduction Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face‐Arm‐Speech‐Time) and BEFAST (Balance‐Eyes‐Face‐Arm Speech‐Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods We sought to analyze the pattern of public educational materials available on the websites US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC‐certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results The FAST mnemonic was listed by 35%of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions Consistency is critical in shaping public health education related to stroke symptoms. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Abstract TP56: Us Comprehensive Stroke Center Utilization Of FAST And BEFAST Mnemonics For Public Education

Introduction: Symptom recognition and timely access to treatment are critical components of acute stroke care systems. Two mnemonics widely used in public educational campaigns for recognizing stroke symptoms include FAST (Face-Arm-Speech-Time) and BEFAST (Balance-Eyes-Face-Arm Speech-Time). The FAST mnemonic, endorsed by the AHA/ASA can miss up to 14% of strokes. BEFAST includes common posterior circulation stroke symptoms and has been implemented by several Comprehensive Stroke Centers (CSCs). Methods: We sought to analyze the pattern of public educational materials available on the websites of US CSCs. The Joint Commission (JC) quality check website compiles a list containing the names and locations of the country’s 217 JC-certified CSCs, which was downloaded in August, 2022. Each CSC’s website was searched for educational material containing FAST and BEFAST mnemonics for stroke symptom recognition. Results: The FAST mnemonic was listed by 35% of CSCs, the BEFAST by 58%, with 7% listing no specific mnemonic. The highest portion of CSCs using BEFAST was in western (65%) and southeastern (63%) states. The highest percentage of CSCs with no listed mnemonic were in the northeastern (14%) and southeastern (13%) states. Conclusions: Consistency is critical in shaping public health education related to stroke symptoms recognition. Our study suggests further effort is needed to unify the public messaging on stroke recognition.

Time is brain

Nursing’s role in timely recognition of stroke symptoms and activation of systems of care.

Factors Influencing Early Hospital Arrival of Patients with Acute Ischemic Stroke, Cross-Sectional Study at Teaching Hospital in Mogadishu Somalia.

The low rates of thrombolysis for ischemic stroke in our country and other developing countries can be attributed to delays in arrival at the hospital. This study aims to investigate the factors that influence the early hospital arrival of patients with acute ischemic stroke to the hospital in Mogadishu, Somalia. This is a cross-sectional study conducted at a teaching hospital in Mogadishu, Somalia. Adult patients with acute ischemic stroke admitted to the emergency department (ED) between June 2021 and May 2022 were included in the study. A questionnaire-based interview was administered to adult patients or their relatives to assess the factors contributing to hospital delay. Of the 212 patients in the study, 113 (53.3%) were male, while 99 (46.7%) were female. The mean age of the patients was 62±10. Hypertension was the most common risk factor among patients 121 (57%), followed by diabetes and hyperlipidemia. One hundred and forty (66%) patients lived in the city, while 72 (34%) lived outside of the city. About 53 (25%) of the patients were brought to the ED by ambulance, and only 32 (15%) reached the hospital in less than 4 hours. The majority of patients had no idea about stroke symptoms and thrombolytic treatment. In univariate and binary logistic regression analysis, delays in hospital arrivals were associated with a travel distance of more than 10 km, transportation via non-ambulance means, living alone, lack of recognition of stroke symptoms, night-time stroke onset, lack of knowledge about thrombolytic treatment, and non-hemiplegic presentation. This study demonstrates factors delaying early hospital arrivals of patients with ischemic stroke. Improving the modifiable factors through public education will prevent delays in the early hospital arrival of stroke patients and will improve early thrombolytic intervention and the overall outcome of these patients.

Prehospital stroke care in Africa: The reality and potential solutions.

Prehospital stroke care in Africa: The reality and potential solutions.

The mucormycosis and stroke: The learning curve during the second COVID-19 pandemic

BackgroundThe Angio-invasive Rhino-orbito-cerebral mucormycosis (ROCM) producing strokes is a less explored entity. Our hospital, a stroke-ready one, had an opportunity to manage mucormycosis when it was identified as the nodal center for mucormycosis management. We are sharing our experiences and mistakes in managing the cerebrovascular manifestations of ROCM. MethodsWe conducted a prospective observational study during the second wave of the COVID-19 pandemic from 1st May 2021 to 30th September 2021, where consecutive patients aged more than 18 years with microbiologically confirmed cases of ROCM were included. Clinical details (timing of stroke onset after ROCM symptoms, GCS, NIHSS), imaging findings (ASPECTS, the territory of stroke, the pattern of infarct, hemorrhagic transformation, cavernous sinus thrombosis), angiogram findings, management details (IV thrombolysis), and outcomes (mRS at discharge and duration of hospital stay) were documented. We also compared the demographics, clinical features (NIHSS), radiological findings, treatment details, duration of hospital stay, and functional outcome at the discharge of the ROCM stroke patients with stroke patients without ROCM. ResultsStroke developed in 42% of patients with ROCM, predominantly anterior circulation border zone ischemic infarcts. Strokes occurred after a median of five days from the onset of ROCM symptoms. The most common vessel involved was the ophthalmic artery, followed by the cavernous ICA. We could not thrombolyse ROCM stroke patients. ROCM patients who developed stroke compared with patients without stroke had a more infiltrative fungal infection and higher inflammatory markers. Mucormycosis associated stroke patients had higher in-hospital mortality and poor functional outcomes.T ConclusionDue to delayed recognition of stroke symptoms, none received reperfusion strategies, leading to poor functional outcomes. For early stroke detection, ROCM cases need frequent monitoring and education of patients and their relatives about the ALS acronym (loss of ambulation, limb weakness, and loss of speech).

Disparities in Reperfusion Therapy and Time Delays Among Patients With Ischemic Stroke and a History of Mental Illness.

Comorbid mental illness may delay recognition of stroke symptoms and reduce the chance of reperfusion therapy. The aim of this study was to compare the use of reperfusion therapy and treatment delays in patients with or without a history of mental illness. A nationwide registry-based cohort study of patients with ischemic stroke. We combined data from the Danish Stroke Registry and the Danish Quality Database for Prehospital Emergency Medical Services from 2016 to 2017 containing information on reperfusion therapy (thrombolysis or thrombectomy) and relevant time stamps. Patients were categorized according to the severity of their mental health history (how recent and severity, for example, hospital- versus primary-based care). A total of 19 592 admissions were included (18% had a minor, 3% had a moderate, and 3% had a history of major mental illness). Significant differences were found regarding age, comorbidity, and socioeconomic factors. Reperfusion therapy was used in 17% of patients. Patients with a history of mental illness were less likely to receive reperfusion therapy: risk ratios with 95% CI were 0.79 (0.72-0.86) for minor, 0.85 (0.72-0.99) for moderate, and 0.63 (0.51-0.77) for patients with a history major mental illness, respectively. Total prehospital delay was longer for patients with a history of major mental illness compared to patients with no history of mental illness, especially when no call had been made to the emergency medical service. The median times from symptom onset to hospital arrival was 811 minutes (197-2845) and 115 minutes (41-188), respectively. We found no differences regarding door-to-needle time, response time, on-scene time, transport time, nor in time-to-imaging among patients arriving within 4 hours from symptoms onset between patients with and without a history of mental illness. Almost one-quarter of patients with ischemic stroke had a history of mental illness. Regardless of severity of mental illness, these patients were less likely to receive reperfusion therapy. Longer delays from symptom onset to hospital arrival contributed to the patients' risk of not being eligible for reperfusion therapy.

Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales.

ObjectivesTo examine whether pre‐hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke.Design, setting, participantsPopulation‐based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 – 31 December 2018.Main outcome measuresEmergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex.ResultsOf 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07–1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93–1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73–2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82–0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre‐hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92–0.97), but the likelihood of basic pre‐hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99–1.04).ConclusionOur large population‐based study identified sex differences in pre‐hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.

Anesthetic consideations for endovascular treatment of acute ischemic stroke.

The purpose of this Continuing Professional Development module is to provide information pertaining to anesthetic considerations and management of endovascular thrombectomy (EVT) for patients with acute ischemic stroke. Acute ischemic stroke is a devastating neurologic disorder and timely intervention is key to a good neurologic outcome. This article provides an overview of three important concepts: pathophysiology and disease characteristics of acute ischemic stroke, and the procedural and anesthetic aspects of EVT. Key considerations include recognition of stroke symptoms, timing and urgency of intervention, procedural considerations for anesthesiologists, risks and benefits of different anesthetic techniques, and a summary of recent guidelines. In particular, current recommendations for blood pressure management in this setting are reviewed. Timely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is effective communication with the multidisciplinary team.

Abstract 064: Prevalence Of Stroke Symptoms Among Hispanic/Latino Adults In The Hispanic Community Health Study/study Of Latinos (HCHS/SOL)

Introduction: In the U.S., Hispanic/Latino adults experience a higher incidence of stroke overall and at younger ages than non-Hispanic White adults. However, given the diversity of U.S. Hispanic/Latinos, understanding heterogeneity in stroke symptom recognition by background is critical to prevention. Methods: The primary outcome was self-reported stroke symptoms over the past year using the validated and telephone-administered Questionnaire for Verifying Stroke Free Status of 8,235 stroke free HCHS/SOL participants in 2017 (mean age=49 + 0.25). Stroke risk factors were collected at baseline (2008-2011) using standardized measurements and validated questionnaires. Stroke risk factors were defined as clinical factors (blood pressure, diabetes, anthropometrics, family history of cardiovascular disease [CVD], smoking, and alcohol consumption), medication use (aspirin, statin, and antihypertensive medication use), and self-reported sociodemographic factors (heritage, sex, education, and years in the mainland US). The prevalence of stroke symptoms and 95% confidence intervals (CI) were estimated overall, by heritage group and by stroke risk factors. Multivariable logistic regression models estimated associations (odds ratio [OR], 95% CI) between heritage group and stroke risk factors with stroke symptoms, accounting for the complex study design and adjusting for age, sex, and sociodemographic factors. Results: Overall, 15% (n=1,448) reported experiencing &gt; 1 stroke symptom in the past year. The most common stroke symptoms reported were sudden numbness (8%) followed by sudden weakness (6%). The prevalence of &gt; 1 stroke symptom among those aged &lt;50 years was 13% and 21% among those &gt; 50. The prevalence was also highest among those of mixed heritage (20%), followed by Puerto Rican heritage (19%), and was lowest among those of Dominican heritage (10%). In age and sex-adjusted models, reporting &gt; 1 stroke symptom was significantly lower among those of Dominican heritage (OR=0.51, 95%CI: 0.40-0.67) and Cuban heritage (OR=0.64, 95%CI: 0.53-0.78) compared to Mexican heritage, while those of mixed heritage exhibited a higher odds (OR=1.58, 95%CI: 1.16-2.15); estimates were unchanged after adjusting for clinical factors and medication. History of diabetes (OR=1.40, 95%CI: 1.17-1.60), CVD (OR=1.94, CI: 1.67-2.26), and current smoking (OR=1.50, 95%CI: 1.28-1.75) were significantly associated with greater odds of reporting &gt; 1 stroke symptom, while odds were lower for males than females (OR=0.78, 95%CI: 0.68-0.89). Conclusions: This is the first study to assess the prevalence of stroke symptoms among U.S. Hispanic/Latino adults and demonstrates a high burden of stroke symptoms in this relatively young population. The prevalence varied across heritage groups and stroke risk factors indicating a need for stroke recognition education and targeted screening.

Abstract 29: Recurrent Stroke Arrival Time

Introduction: All stroke patients and family members should receive stroke education including recognition of stroke symptoms and prompt activation of emergency medical (EMS). The impact of this education is unclear. We aimed to measure the association between EMS use and timing of arrival within first ever and recurrent strokes. Methodology: The study analyzed data from validated strokes identified by the Brain Attack Surveillance in Corpus Christi (BASIC) project between 1/1/2000-1/1/2020. We analyzed 5,617 first-ever strokes (FES), 259 instances of recurrent stroke within 1 year of the first (RS1), and 2,044 recurrent strokes over 1 year or unknown duration from the first (RS0). Following imputation, recurrent stroke’s associations with both EMS arrival (available post-2010) and early arrival (&lt; 3hrs) were assessed with logistic models, accounting for clustering with generalized linear models (GEEs). Results: Compared to FES, there was significantly higher unadjusted odds of arrival by EMS, but not early arrival, for one of the recurrent stroke groups (Table 1; RS0: OR = 1.29, 95% CI=1.10-1.50; RS1:OR=1.24, CI=0.87-1.75). The association was not significant after adjustment. Increasing stroke severity, married status and EMS use were associated with higher odds of early arrival, while African Americans (AAs) had lower odds than non-Hispanic Whites (NHWs, Table 1). However, AAs did have higher odds of EMS use relative to NHWs. Those who were married and living together had lower odds of EMS use compared to those who were not. Conclusion: Our study examines the association of repeat stroke on early arrival and EMS use as a surrogate for adequate stroke education. By examining subsets, we can identify groups that would benefit from targeted education. For example, younger, non-AA patients with smaller strokes would benefit from more education on EMS use and African American patients would benefit from education related to faster recognition or urgency of presentation.