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Acute Stroke in the Emergency Department: Profiles of Patients and Obstacles to Acute Intervention

Ashish N Bosco1, Shakuntala Murthy1, Girish Narayan1

  • 1Emergency Medicine, St. John's Medical College, Bangalore, IND.

Cureus
|August 8, 2024
PubMed

Insights

This study profiles emergency department stroke patients, finding few receive timely thrombolysis due to presentation delays. Stroke subtypes significantly impact interventions and outcomes, highlighting challenges in acute stroke care.

Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Stroke is a leading cause of death and disability worldwide.
  • Understanding patient demographics and treatment patterns is crucial for improving stroke care.
  • Subtypes of stroke, including ischemic, hemorrhagic, and cerebral venous thrombosis (CVT), require distinct management strategies.

Purpose of the Study:

  • To characterize the demographic profile of emergency department (ED) stroke patients.
  • To determine the rates of successful thrombolysis and active interventions.
  • To analyze patient outcomes from ED presentation through hospital discharge or death.

Main Methods:

  • Consecutive recruitment of 216 patients presenting to the ED with stroke.
  • Data collection on demographics, stroke type, treatment, and outcomes.
  • Statistical analysis using mean, standard deviation, and chi-square tests.
  • Stratification of data by stroke subtype: ischemic, hemorrhagic, and CVT.

Main Results:

  • The study included 216 patients (72% male, 28% female) with a mean age of 56.57 years.
  • Ischemic stroke (63%) was most common, followed by hemorrhagic (31%) and CVT (6%).
  • Only 5.5% presented within the 'golden hour'; 9 out of 28 ischemic strokes received thrombolysis.
  • Interventions varied by subtype, with surgical decompression common in hemorrhagic strokes.

Conclusions:

  • Stroke is a heterogeneous condition with significant subtype-specific differences.
  • Barriers exist in early hospital presentation and timely initiation of thrombolysis.
  • Improved strategies are needed to overcome obstacles in acute stroke intervention.
Abstract

Keywords:
emergency departmentgolden hourstrokethrombolysiswindow

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