Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Predictors for Critical Care Resource Utilization Following Intravenous Alteplase for Acute Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
P8 - Poster Session 8 (8:00 AM-9:00 AM)
4-001

Determine predictors for critical care resource utilization in patients receiving intravenous alteplase (IVT) for management of acute ischemic stroke (AIS).

Guidelines for early management of AIS recommend that patients who receive IVT should be admitted to an intensive care (ICU) or stroke unit for serial neurological assessments and frequent blood pressure monitoring. Given the emergence of dedicated stroke or progressive care units worldwide, there may be a need for evidence-based risk stratification in these patients to improve healthcare utilization.
In this retrospective, single institution study, stroke alert and admission data were collected for seventy patients who received IVT for AIS during a one-year period. Vascular syndrome was determined after review of presenting clinical symptoms, including initial National Institutes of Health Stroke Scale (NIHSS). Need for ICU level care was determined after review of patient’s hospital course, including number of continuous vasoactive medications administered, invasive monitoring required, and procedures performed. Multivariate analysis and logistic regression modeling were conducted to identify predictors of ICU resource needs in these patients.

Twenty-two out of seventy patients (31.4%) who received IVT required ICU level resources beyond serial blood pressure monitoring and neurological assessments. Two patients (2.8%) developed symptomatic intracerebral hemorrhage, and three patients (4.3%) developed significant neurological worsening (defined as ≥4 point increase in 24 hour post-tPa NIHSS). Using multivariate analysis, initial NIHSS >10 was significantly associated with increased need for ICU level resources overall (RR 2.04; 95% CI [1.01, 4.13]). Logistic regression analysis revealed that full left or right middle cerebral artery (MCA) syndrome on arrival was a predictor for number of ICU resources required during admission (OR 5.812; 95% CI [1.182, 28.57]).

Full MCA syndrome on arrival and initial NIHSS >10 may predict increased utilization of ICU level resources in patients who receive IVT for management of AIS.  
Authors/Disclosures
Ritwik Bhatia, MD (University of California, San Francisco, Dept of Neurology)
PRESENTER 		Dr. Bhatia has nothing to disclose.
Andres De Leon, MD (Emory University) Dr. De Leon has nothing to disclose.
Vasu Saini, MD Dr. Saini has nothing to disclose.
Kristine H. O'Phelan, MD (University of Miami) Dr. O'Phelan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bard Medical. Dr. O'Phelan has a non-compensated relationship as a DSMB member SIREN network with NIH/NINDS that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Sebastian Koch, MD (University of Miami) Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.