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Published on: January 15, 2017
Clinical routines and structural resources for performing transoesophageal echocardiography on German stroke units
Damjan Mirkov1, Adeeb Qabalan1, Peter A Ringleb1
1Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Insights
Transoesophageal echocardiography (TOE) rates vary in German stroke units, influenced by patient volume and certification. Standardized procedures for TOE indications are lacking, highlighting a need for improved guidelines.
Area of Science:
- Neurology
- Cardiology
- Medical Imaging
Background:
- Transoesophageal echocardiography (TOE) is crucial for detecting cardiac embolism sources in acute ischemic stroke (AIS) and transient ischemic attack (TIA) patients.
- Current recommendations for echocardiography post-stroke are vague due to a lack of randomized controlled trials.
- Clinical practices and resources for performing TOE on stroke units can differ significantly.
Purpose of the Study:
- To investigate the structural conditions and logistical factors influencing the performance of TOE on certified stroke units in Germany.
- To evaluate the factors impacting the decision-making process for performing TOE in stroke patients.
Main Methods:
- A prospective, exploratory, cross-sectional survey was conducted.
- Anonymous questionnaires were distributed to clinical leads of certified stroke units in Germany.
- The survey focused on stroke unit characteristics, TOE logistics, and local indications for TOE, including influencing factors.
Main Results:
- Data from 248 stroke units (SUs) were analyzed, with a median TOE rate of 23.0%.
- Lower TOE rates correlated with higher patient numbers; longer waiting times were linked to certification level and patient volume.
- A significant percentage of SUs lacked standardized operating procedures (SOPs) for TOE indications, despite general consensus on clinical indications.
Conclusions:
- The study offers insights into TOE practices for hospitalized German stroke patients, despite limitations.
- Findings can aid in optimizing TOE utilization and developing future guidelines and SOPs, especially within resource constraints.
Background:
Transoesophageal echocardiography (TOE) is essential for identifying cardiac sources of embolism in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). As randomized controlled trials are missing, recommendations regarding echocardiography after stroke remain vague, and clinical routines and structural resources for performing TOE on stroke units may differ. We here examined structural conditions for performing TOE on certified stroke units in Germany, and evaluated factors that may influence the decision to perform TOEs.
Methods:
In this prospective exploratory cross-sectional survey, a standardized anonymous questionnaire was sent to all clinical leads of certified stroke units in Germany, supported by the German Stroke Society. The questionnaire focused on (a) on general characteristics of stroke units and logistics of TOE examinations and (b) local indication for performing TOEs, with a focus on factors that may influence this decision.
Results:
Data from 248 SUs (stroke units) were included into the analysis (response rate 71.1%). The reported median TOE rate was 23.0% (IQR 18-34). Lower TOE rates were related to increasing numbers of stroke patients (p = 0.048). Most TOEs were performed within 24-48 h after the request (49.6%). Longer waiting times for TOE were associated with level of certification (p < 0.001) and higher numbers of stroke patients (p = 0.002). The presence of a stroke unit cardiologist did not result into shorter waiting times (p = 0.238). In total, 23.8% of the responding stroke units do not have a standardized operating procedure (SOP) for indicating TOE. Though 50% of leads considered quantitative requirements for indicating TOEs, within certain clinical contexts and situations, our findings revealed a broad consensus among stroke unit leads concerning TOE indications.
Conclusions:
Despite limitations, our study provides valuable insights into performing TOE in hospitalized German stroke patients. This may facilitate the optimized use of TOE in hospitals and represent a first step towards the development of future guidelines and SOPs, in particular in the context of limited resources.
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