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Analysis of 30 Day Unexpected Readmission Rates in Stroke Patients at an Academic Acute-care Hospital (P5.151)
CONCLUSIONS:SNFs accounted for the greatest percentage of unexpected stroke patient readmissions occurring within 30 days, while IR accounted for none. Main readmitting causes included cerebrovascular, cardiovascular, infections, and dehydration. 70[percnt] of readmissions were geriatric patients. Study Supported by: None.Disclosure: Dr. Kushner has nothing to disclose. Dr. Kelly has nothing to disclose. Dr. Morrison has nothing to disclose. Dr. Camfield has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Kushner, D., Kelly, E., Morrison, R., Camfield, K. Tags: Cerebrovascular Disease and Interventional Neurology: Quality Research and Initiatives Source Type: research

Strategies for Optimizing Acute Ischemic Stroke Care by Reducing Door to Needle Time in a Major Academic Center (P4.280)
Conclusion: Through the identification and analysis of key metrics in the acute stroke pathway by the neurology team, DTN times were significantly improved within a brief period of time. As the benefits of IV tPA are time dependent, it is critical that hospitals work to optimize acute stroke protocols. By implementing the innovative changes of the neurology house staff, institutions nationwide can achieve similar rapid gains in DTN times and provide effective treatment to a greater percentage of patients with acute ischemic stroke.Disclosure: Dr. Abraham has nothing to disclose. Dr. Oksienik has nothing to disclose. Dr. Be...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Abraham, J., Oksienik, C., Bell, R., Skidmore, C., Tzeng, D., Pineda, C. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Ischemic Stroke Care Source Type: research

Routine troponin measurements are unnecessary in acute ischemic stroke evaluations (P4.285)
CONCLUSIONS: Troponin elevation in patients with ischemic stroke is not caused by acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponins should be measured based on clinical context rather than routinely in all acute ischemic stroke patients.Disclosure: Dr. Ali has nothing to disclose. Dr. Young has nothing to disclose. Dr. Rabinstein has received royalty payments from Elsevier and Oxford University Press. Dr. Rabinstein has received research support from DJO Global. Dr. Flemming has nothing to disclose. Dr. Fugate has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Ali, F., Young, J., Rabinstein, A., Flemming, K., Fugate, J. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Ischemic Stroke Care Source Type: research

Does Resident Level of Training Affect Time to tPA Treatment? (P4.292)
CONCLUSIONS: While no overall difference was seen in DTN or RWT between different levels of training, there was significant variance in resident work time between the junior residents. Future analysis will focus on specific areas of variance in order to direct future training initiatives.Disclosure: Dr. Bishop has nothing to disclose. Dr. Guzik has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Bishop, L., Guzik, A. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Ischemic Stroke Treatment Source Type: research

Reducing Door-To-Needle Times for Treatment of Acute Ischemic Stroke: Quality Improvement Initiative at a High Volume Comprehensive Stroke Center (P4.309)
CONCLUSION: With multiple institution specific interventions it is possible to improve the DTN time even at a high volume non-academic center. One of the key component appears to be the in-house presence of a stroke neurologist 24hours /7days a week.Disclosure: Dr. Sapkota has nothing to disclose. Dr. Sirelkhatim has nothing to disclose. Dr. Devlin has received personal compensation for activities with Concentric Medical, Inc. as a consultant. Dr. Pitiyanuvath has nothing to disclose. Dr. Dellinger has nothing to disclose. Dr. Fesmire has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sapkota, B., Sirelkhatim, A., Devlin, T., Pitiyanuvath, N., Dellinger, C., Fesmire, F. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Stroke, Prehospital, and Telemedicine Source Type: research

Continued Participation in a Telestroke Program Improves Time to Intravenous Thrombolysis (P4.315)
Conclusions: Maturation of a telestroke program is associated with improvement in the timeliness of IV tPA delivery. This improvement is due to faster responses in both the hub site (recommending IV tPA earlier) and spoke site (administering IV tPA quicker). Further studies aimed at improving delivery of IV tPA in telestroke program are warranted.Disclosure: Dr. Muthana has nothing to disclose. Dr. Conners has nothing to disclose. Dr. Cutting has nothing to disclose. Dr. Song has nothing to disclose. Dr. Diebolt has nothing to disclose. Dr. Bock has nothing to disclose. Dr. Lee has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Muthana, J., Conners, J., Cutting, S., Song, S., Diebolt, E., Bock, J., Lee, V. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Stroke, Prehospital, and Telemedicine Source Type: research

Balancing Autonomy and Beneficence in Acute Stroke Therapy: Neurologist Attitudes Toward Delaying Thrombolysis in Order to Obtain Informed Consent (P7.332)
CONCLUSIONS: Vascular neurologists indicate they emphasize beneficence over autonomy in deciding when to forego further attempts to reach consent providers to proceed with thrombolytic therapy under the doctrine of presumed consent. Their preference for rapid intervention is magnified when decisions are framed in person failure to benefit and neuron loss, compared with simple chronologic time.Disclosure: Dr. Kaplan has nothing to disclose. Dr. Cranston has nothing to disclose. Dr. Saver has received personal compensation for activities with the University of California, BrainsGate, CoAxia, eV3, Talecris Biotherapeutics Inc...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Kaplan, B., Cranston, J., Saver, J. Tags: Practice, Policy, and Ethics Source Type: research

Demographics and Impact on Diagnosis of Neurological Consultations in the ICU (P5.035)
CONCLUSIONS: The neurology consult service had a measurable impact on diagnosis in ICU patients, changing the diagnosis in 75[percnt], and may, therefore, make an important contribution to management and outcomes of these patients.Disclosure: Dr. Weathered has nothing to disclose. Dr. Lennihan has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Weathered, N., Lennihan, L. Tags: Neuroepidemiology: Aging, Dementia, Cognitive, and Behavioral Neurology, General Neurology, and Research Methodology and Education Source Type: research

Engaging Residents in Stroke Quality Measures with Financial Incentives and Electronic Checklist (S11.007)
CONCLUSIONS: Implementing a real-time, interactive decision support checklist and pay-for-performance program for residents improved compliance with stroke process measures. Empowering residents through leadership roles has been an important step toward integrating them into the quality infrastructure of the health system.Disclosure: Dr. Dean has nothing to disclose. Dr. Rashid has nothing to disclose. Dr. Wiese-Rometsch has nothing to disclose. Dr. Arsene has nothing to disclose. Dr. Hamstra has nothing to disclose. Dr. White has nothing to disclose. Dr. Hussain has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Dean, M., Rashid, S., Wiese-Rometsch, W., Arsene, C., Hamstra, C., White, S., Hussain, S. Tags: Practice, Policy, and Ethics Source Type: research

Anxiety influences TIA diagnosis (P7.134)
Conclusions: We found an elevated TIA-IS ratio among patients with a concurrent ICD9 code for anxiety. The ABCD2 score, assessing symptoms and vascular risk factors, is promoted as a criterion for admission; however, these data suggest that comorbid conditions such as anxiety along with demographic and hospital factors also influence TIA diagnosis. The validity and meaning of an ICD9 code for anxiety is uncertain. The code may be associated with over-diagnosis of TIA as well as increased recognition of true TIA.Disclosure: Dr. Sugrue has nothing to disclose. Dr. Bhupali has nothing to disclose. Dr. Labovitz has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sugrue, W., Bhupali, D., Labovitz, D. Tags: Cerebrovascular Disease and Interventional Neurology: Stroke, Depression, and Anxiety Source Type: research

Intravenous Tissue Plasminogen Activator Treatment for Acute Ischemic Stroke in the REGARDS Study (P7.138)
CONCLUSIONS:Our study of unselected US hospitals showed low tPA utilization. Documented reasons for non-use were suboptimal with the lowest among patients not evaluated by a stroke team. Our sample was not limited to hospitals participating in national quality improvement programs, thus increasing generalizability. Strategies that focus on earlier hospital arrival and educating both the public and healthcare field to increase tPA utilization are urgently needed.Disclosure: Dr. Sands has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Blackburn has nothing to disclose. Dr. Boehme has nothing to disclose. Dr. ...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sands, K., Albright, K., Blackburn, J., Boehme, A., Howard, G., Howard, V., Judd, S., Kissela, B., Limdi, N., Rhodes, D., Shiue, H., Sisson, A., Safford, M. Tags: Cerebrovascular Disease and Interventional Neurology: Race, Ethnicity, and Stroke Source Type: research

Race Does Not Predict Discharge Functional Status in Acute Ischemic Stroke Patients with Renal Impairment after Systemic tPA (P7.142)
Conclusions: Our data are consistent with previous studies that renal impairment is a predictor of poor discharge outcome. Although limited by relatively small numbers, our analysis did not demonstrate AA race predicted poor discharge functional status.Disclosure: Dr. Sands has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Shiue has nothing to disclose. Dr. Bavarsad Shahripour has nothing to disclose. Dr. Alexandrov has received personal compensation for activities with Genentech, Inc.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sands, K., Kumar, G., Shiue, H., Bavarsad Shahripour, R., Alexandrov, A. Tags: Cerebrovascular Disease and Interventional Neurology: Race, Ethnicity, and Stroke Source Type: research

Delay in IV tPA decision making early in the academic year (P6.230)
CONCLUSIONS: An isolated increase in door-to-needle IV tPA time without change in response time or time to CT at the beginning of a new academic year suggests a delay in decision making by new residents. We plan to develop a training module for incoming residents that focuses on rapid decision making in the delivery of IV tPA to ischemic stroke patients. Study Supported by: noneDisclosure: Dr. Sidorov has nothing to disclose. Dr. Haxton has nothing to disclose. Dr. Gorman has nothing to disclose. Dr. Gordon has nothing to disclose. Dr. Chaudhary has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Sidorov, E., Haxton, M. E., Gorman, L., Gordon, D., Chaudhary, S. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Thrombolysis Source Type: research

Overcoming Framing Bias in Stroke Neurologists' Assessments of the Minimally Clinically Important Difference for Novel Acute Ischemic Stroke Therapies (P4.187)
CONCLUSIONS: When assessed with framing based on clinical practice rather than convenience, vascular neurologists indicated the MCID for a safe agent to be worthwhile to use in acute ischemic stroke is about 1[percnt]. Drug and device agencies should consider this value to be the expert opinion MCID for acute ischemic stroke treatments when making regulatory decisions.Disclosure: Dr. Cranston has nothing to disclose. Dr. Kaplan has nothing to disclose. Dr. Saver has received personal compensation for activities with the University of California, BrainsGate, CoAxia, eV3, Talecris Biotherapeutics Inc., and PhotoThera, Inc.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Cranston, J., Kaplan, B., Saver, J. Tags: Research Methodology and Education Source Type: research

Concussion and the neurologist: A work in progress
In the last 3 decades, the neurology landscape has changed. Once primarily an academic profession with limited treatment options, neurology now is a clinical field with treatments available in the acute care setting. Treatment of an acute ischemic stroke may begin with tissue plasminogen activator given in the emergency room within 4.5 hours of symptoms.1 This clinical shift now includes the evaluation and management of concussion patients. With the current estimate from the Centers for Disease Control and Prevention being 1.6–3.8 million sports- and recreation-related concussions per year (up from the prior estimate...
Source: Neurology - July 21, 2014 Category: Neurology Authors: Deibert, E. Tags: EDITORIALS Source Type: research

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