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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
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Code stroke: multicenter experience with in-hospital stroke alerts.

Ethan Cumbler1, Jennifer Simpson

  • 1Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; National Stroke Association, Centennial, Colorado.

Journal of Hospital Medicine
|December 25, 2014
PubMed
Summary
This summary is machine-generated.

Hospitalized patients experiencing stroke symptoms require rapid evaluation. In-hospital stroke response teams must prepare for various neurological conditions, not just ischemic stroke.

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Area of Science:

  • Neurology
  • Quality Improvement
  • Public Health

Background:

  • A significant percentage of strokes occur during hospitalization for other conditions.
  • Rapid evaluation systems are crucial for managing in-hospital strokes.
  • Previous data on the characteristics of in-hospital stroke alerts is limited.

Purpose of the Study:

  • To evaluate the effectiveness of an in-hospital stroke quality-improvement initiative.
  • To analyze the types of acute neurological events and stroke mimics identified through an in-hospital stroke alert system.
  • To assess the utilization of thrombolytic therapies in hospitalized stroke patients.

Main Methods:

  • A quality-improvement initiative was implemented across six certified stroke centers.
  • Data from 393 in-hospital stroke alerts over one year were retrospectively analyzed.
  • Alerts were categorized into ischemic stroke, transient ischemic attack (TIA), intracranial hemorrhage, and stroke mimics.

Main Results:

  • Nearly half (46.1%) of stroke alerts were identified as stroke mimics, most commonly seizure, hypotension, and delirium.
  • Ischemic stroke accounted for 42.5% of alerts, while TIA and intracranial hemorrhage were less frequent.
  • Thrombolytic therapy was administered to a subset of confirmed stroke/TIA cases, with no mimics receiving treatment.

Conclusions:

  • In-hospital stroke response teams encounter a diverse range of acute neurological conditions, including a high proportion of stroke mimics.
  • The findings underscore the need for comprehensive diagnostic capabilities within hospital-based stroke response systems.
  • Preparedness for non-stroke neurological emergencies is essential for effective in-hospital stroke care.