ABSTRACT
Mobile Stroke Unit (MSU) expedites the delivery of intravenous thrombolysis in acute stroke patients. We further evaluated the functional outcome of patients shipped to a tertiary care centre or repatriated to local hospitals after triage by MSU in acute stroke syndrome in rural northern Alberta. Consecutive patients with suspected acute stroke syndrome were included. On the basis of neurology consultation and, Computed Tomography findings, patients, who were thrombolysed or needed advanced care were transported to the Comprehensive stroke center (CSC) (Triage to CSC group). Other patients were repatriated to local hospital care (Triage to LHC group). A total of 156 patients were assessed in MSU, 73 (46.8%) were female and the mean age was 66.6 ± 15 years. One hundred and eight (69.2%) patients, including 41 (26.3%) treated with thrombolysis were transported to the CSC (Triage to CSC group) and 48 (30.8%) were repatriated to local hospital care. The diagnosis made in MSU and final diagnosis were matching in 88% (95) and 91.7% (44, p = 0.39) in Triage to CSC and Triage to LHC groups respectively. Prehospital triage by MSU of acute stroke syndrome can reliably repatriate patients to the home hospital. The proposed model has the potential to triage patients according to their medical needs by enabling treatment in home hospitals whenever reasonable.
Subject(s)
Emergency Medical Services , Mobile Health Units , Stroke/diagnostic imaging , Stroke/diagnosis , Tomography, X-Ray Computed , Triage , Aged , Aged, 80 and over , Alberta , Female , Humans , Male , Middle Aged , Stroke/therapy , Thrombolytic Therapy , Time-to-TreatmentSubject(s)
Education, Medical, Graduate/organization & administration , Fellowships and Scholarships , Neurology/education , Stroke/therapy , Adult , Aged , Aged, 80 and over , Alberta , Cerebral Angiography , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/therapy , Computed Tomography Angiography , Education, Medical, Graduate/statistics & numerical data , Endovascular Procedures , Female , Hemorrhagic Stroke/diagnosis , Hemorrhagic Stroke/therapy , Hospitals, University , Humans , Ischemic Attack, Transient/diagnosis , Ischemic Attack, Transient/therapy , Ischemic Stroke/diagnosis , Ischemic Stroke/therapy , Male , Middle Aged , Stroke/diagnosis , Subarachnoid Hemorrhage/diagnosis , Subarachnoid Hemorrhage/therapy , Thrombectomy , Thrombolytic Therapy , Tomography, X-Ray Computed , Young AdultABSTRACT
Background: A rapid and reliable method to predict significant early hematoma growth in the acute setting is of great important to better inform clinicians and researchers in their efforts to improve outcomes for patients. Methods: We established a 10-point score system to predict hematoma growth including four parameters: baseline intracerebral hemorrhage (ICH) volume > 30 mL, time to initial CT scan ≤ 3 h, island sign and black hole sign. Then, we reviewed our ICH database and assessed the predict value of the score system. Results: A total of 216 ICH patients were included. Patients with hematoma growth at 24 h had higher score than those without hematoma growth (7.6 ± 3.0 vs. 2.0 ± 2.4, p < 0.001). The optimal cut-off value of the score for predicting hematoma growth was 3 (area under curve, 0.937; 95% CI, 0.899-0.975, p < 0.001), with 95% CI of 0.896-0.965 in bootstrapping analysis. The sensitivity, specificity, positive predictive and negative predictive value of the score ≥ 3 for predicting hematoma growth were 97.8, 92.7, 90.9, and 98.3%. Conclusion: The 10-point score system could predict hematoma growth with high accuracy.
ABSTRACT
In this case report, we describe a patient who has a persistent left superior vena cava (PLSVC) manifesting as a transient ischemic attack (TIA) and a remote brain abscess. PLSCV, when draining in the left atrium, is a cause of right to left shunt, and it has been related to brain abscesses and, as reported in a few cases, to ischemic stroke. After admission, our patient experienced 2 new episodes of TIA while being injected with agitated saline contrast through the left arm, producing echocardiographic images of right to left shunt, which gave the clue to the diagnosis.