12 versus 24 h bed rest after acute ischemic stroke thrombolysis: a preliminary experience.

BACKGROUND: The practice of ≥24 h of bed rest after acute ischemic stroke thrombolysis is common among hospitals, but its value compared to shorter periods of bed rest is unknown. METHODS: Consecutive adult patients with a diagnosis of ischemic stroke who had received intravenous thrombolysis treatment from 1/1/2010 until 4/13/2016, identified from the local ischemic stroke registry, were included. Standard practice bed rest for ≥24 h, the protocol prior to 1/27/2014, was retrospectively compared with standard practice bed rest for ≥12 h, the protocol after that date. The primary outcome was favorable discharge location (defined as home, home with services, or acute rehabilitation). Secondary outcome measures included incidence of pneumonia, NIHSS at discharge, and length of stay. RESULTS: 392 patients were identified (203 in the ≥24 h group, 189 in the ≥12 h group). There was no significant difference in favorable discharge outcome in the ≥24 h bed rest protocol compared with the ≥12 h bed rest protocol in multivariable logistic regression analysis (76.2% vs. 70.9%, adjusted OR 1.20 CI 0.71-2.03). Compared with the ≥24 h bed rest group, pneumonia rates (8.3% versus 1.6%, adjusted OR 0.12 CI 0.03-0.55), median discharge NIHSS (3 versus 2, adjusted p = .034), and mean length of stay (5.4 versus 3.5 days, adjusted p = .006) were lower in the ≥12 h bed rest group. CONCLUSION: Compared with ≥24 h bed rest, ≥12 h bed rest after acute ischemic stroke reperfusion therapy appeared to be similar. A non-inferiority randomized trial is needed to verify these findings.

Hospital-directed feedback to Emergency Medical Services improves prehospital performance.

BACKGROUND AND PURPOSE: A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers. METHODS: A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods. RESULTS: We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (P<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period. CONCLUSIONS: Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.