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Specialty: Emergency Medicine
Condition: Stroke

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Total 1739 results found since Jan 2013.

Stroke Mimics and Acute Stroke Evaluation: Clinical Differentiation and Complications after Intravenous Tissue Plasminogen Activator
Intravenous tissue-plasminogen activator remains the only U.S. Food and Drug Administration-approved treatment for acute ischemic stroke. Timely administration of fibrinolysis is balanced with the need for accurate diagnosis. Stroke mimics represent a heterogeneous group of patients presenting with acute-onset focal neurological deficits. If these patients arrive within the extended time window for acute stroke treatment, these stroke mimics may erroneously receive fibrinolytics.
Source: The Journal of Emergency Medicine - March 22, 2015 Category: Emergency Medicine Authors: Peggy L. Nguyen, Jason J. Chang Tags: Clinical Review Source Type: research

Direct oral anticoagulants in the secondary prevention of stroke and transient ischemic attack in patients with atrial fibrillation
Abstract In patients with non-valvular atrial fibrillation (NVAF) and history of transient ischemic attack (TIA) or stroke, the rate of vascular events is higher in comparison to patients without history of stroke or TIA. A meta-analysis of direct oral anticoagulants (DOACs) studies, including only patients with history of stroke or TIA, report a significant reduction of 15 % in the rates of composite of stroke and systemic embolism in patients treated with DOACs, compared to those treated with warfarin. Furthermore, a reduction of 14 % for major bleeding, as well as a 56 % reduction for hemorrhagic stroke over...
Source: Internal and Emergency Medicine - April 11, 2015 Category: Emergency Medicine Source Type: research

Effect of Treatment Delay, Age, and Stroke Severity on the Effects of Intravenous Thrombolysis with Alteplase for Acute Ischaemic Stroke: A Meta-analysis of Individual Patient Data from Randomized Trials
Ischemic stroke is a common medical condition that carries significant morbidity and mortality. Treatment with alteplase is a controversial modality that comes with significant risks and benefits. The authors of this study sought to analyze effects of age, time to treatment, and severity of stroke on stroke outcomes in patients treated with alteplase. A meta-analysis was performed, with a total of 6756 patients from nine randomized trials comparing alteplase with placebo or open control. Positive stroke outcomes were defined by this study as no significant disability at 3–6 months, as defined by a modified Rankin Score of 0 or 1.
Source: The Journal of Emergency Medicine - May 1, 2015 Category: Emergency Medicine Authors: Graham Ingalsbe Tags: Abstract Source Type: research

Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke
Conclusion For patients hospitalized for acute ischemic stroke, computerized physician order entry use was associated with increased use of intravenous tissue plasminogen activator.
Source: Annals of Emergency Medicine - September 9, 2015 Category: Emergency Medicine Source Type: research

Patient and process factors associated with type of first neuroimaging and delayed diagnosis in childhood arterial ischemic stroke.
CONCLUSIONS: Strategies to improve rapid diagnosis of pediatric stroke should include shared regional hospital networks protocols to optimize local imaging strategies, and where possible rapid transfer to the tertiary center. Future priorities should include development of pediatric ED physician decision support tools to differentiate stroke from mimics, and the development and implementation of rapid ED imaging stroke protocols to improve access to confirmatory MRI scanning. This article is protected by copyright. All rights reserved. PMID: 27155309 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - May 6, 2016 Category: Emergency Medicine Authors: Daverio M, Bressan S, Gregori D, Babl FE, Mackay MT Tags: Acad Emerg Med Source Type: research

What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke?
The objective of this study is to detect the subgroup of patients with such presentations having minor strokes whom may benefit from primary and secondary stroke prevention. We conducted a retrospective analysis and stratified patient risk factors associated with positive findings on subsequent head MRI ordered by the emergency department physician following a normal head CT. Two hundred fifty-two patients presenting with atypical stroke symptoms to the emergency department had a negative head CT followed by head MRI within 24 h ordered by emergency department clinician (123 males and 129 females; mean age of 59.4). Twent...
Source: Emergency Radiology - May 23, 2016 Category: Emergency Medicine Source Type: research

Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke
The time to thrombolysis, commonly termed “door-to-needle” (DTN) is a measure of stroke center quality and effective patient care. The 2013 American Heart Association/American Stroke Association (AHA/ASA) Guidelines for the Early Management of Patients with Acute Ischemic Stroke recommend that hospitals administer thrombolytics to all eligible ischemic stroke patients in less than 60 minutes from arrival [1]. Time to initiation of thrombolytics in ischemic stroke patients has been associated with improved neurological outcomes, decreased adverse effects, and reduced mortality with early thrombolysis associated with the...
Source: The American Journal of Emergency Medicine - July 5, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall, Georgia Keriazes Source Type: research

No space left for intravenous thrombolysis in acute stroke: PROS
Abstract Five recently published RCTs (MR CLEAN, EXTEND-IA, SWIFT PRIME, REVASCAT and ESCAPE) employing mechanical thrombectomy with modern stent retriever devices clearly demonstrated the superiority of endovascular treatment compared to thrombolysis alone, which is now considered standard first-line therapy for selected patients with acute severe ischemic stroke and large vessel in the anterior circulation. RCT results led to recommendations outlined in “Mechanical thrombectomy in acute ischemic stroke by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN”. Moreover, endovascular...
Source: Internal and Emergency Medicine - July 19, 2016 Category: Emergency Medicine Source Type: research

Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke
The time to thrombolysis, commonly termed “door-to-needle” (DTN) is a measure of stroke center quality and effective patient care. The 2013 American Heart Association/American Stroke Association (AHA/ASA) Guidelines for the Early Management of Patients with Acute Ischemic Stroke recommend that hospitals administer thrombolytics to all e ligible ischemic stroke patients in less than 60 minutes from arrival [1]. Time to initiation of thrombolytics in ischemic stroke patients has been associated with improved neurological outcomes, decreased adverse effects, and reduced mortality with early thrombolysis associated with th...
Source: The American Journal of Emergency Medicine - July 5, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall, Georgia Keriazes Source Type: research

Stakeholder engagement in the design of a novel pre-hospital acute stroke assessment
Conclusions Following the interviews significant alterations were made to the intervention and protocol in order to improve trial feasibility, acceptability and data quality. This emphasizes the importance of engaging with ambulance services, other clinical teams and patients during the development of pre-hospital research protocols.
Source: Emergency Medicine Journal - August 17, 2016 Category: Emergency Medicine Authors: Lally, J., McClelland, G., Exley, C., Ford, G., Price, C. Tags: Poster Presentations Source Type: research

External Validation of the ASTRAL and DRAGON Scores for Prediction of Functional Outcome in Stroke
The ability to predict outcomes after acute stroke facilitates treatment and eases communication with patients. Acute Stroke Registry and Analysis of Lausanne (ASTRAL) was developed for use in acute ischemic stroke patients and does not require imaging. The other score is designed for stroke patients that have been treated with intravenous tissue-type plasminogen activator (tPA) includes dense middle cerebral artery sign, prestroke modifed Rankin Scale score [mRS], age, glucose, onset to treatment, National Institutes of Health Stroke Scale [NIHSS] score (DRAGON).
Source: The Journal of Emergency Medicine - September 30, 2016 Category: Emergency Medicine Authors: Nigel S. George Tags: Abstract Source Type: research

Stroke Ambulance Brings Urgent Stroke Care to Alberta
However, the use of thrombolysis (clot-busting drugs) for stroke has been found to be fairly low in Canada –only around 6%of cases – mostly limited by patients not arriving in hospital within the treatment time window. Now, stroke teams in Edmonton have brought a new player into the mix, to help more patients get their treatment within the time window: a stroke ambulance, also known as a Mobile Stroke Unit. Read More at Ottawa Citizen
Source: JEMS Patient Care - December 20, 2016 Category: Emergency Medicine Tags: News Ambulances & Vehicle Ops Patient Care Source Type: news

Does early onset cataract increase the risk of ischemic stroke? A nationwide retrospective cohort study
This study was attempted to address the association between early onset cataract (EOC) and ischemic stroke. Using the Longitudinal Health Insurance Database 2000, we established an EOC cohort and a comparison cohort by using 4-fold propensity score matching according to age, gender and comorbidities to detect the incidence of ischemic stroke. A Cox model was used to express the risk of ischemic stroke for the EOC patients compared with the comparison cohort. After adjusting for age, gender and comorbidities of hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, asthma, chronic obstructive pulmonary...
Source: Internal and Emergency Medicine - December 21, 2016 Category: Emergency Medicine Source Type: research