Stroke patient evaluation in the emergency department before pharmacologic therapy

Beverly L. Timerding, William G. Barsan, Jerris R. Hedges, Thomas G Brott, Peter F. VanLigten, Judith A. Spilker, Charles P. Olinger

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

The standard of care for acute thromboembolic stroke is changing rapidly with the advent of new pharmacologic therapies. The deterioration of focal cerebral ischemia to infarction can be lessened with timely restoration of cerebral blood flow. As pharmacologic therapy of acute stroke evolves, emergency physicians will increasingly facilitate its implementation. The purpose of this study was to elucidate those factors significantly affecting the acute stroke patient's emergency department (ED) evaluation time. The pretreatment ED evaluations of 20 patients entered in an ongoing trial of a fibrinolytic agent (ancrod) for acute ischemic stroke were reviewed. Pretreatment screening factors included the assessment of hematologic status, concurrent illness, and potential neoplastic disease or cerebral hemorrhage as the etiology for the neurological deficit. The following factors had a statistically significant effect on pretreatment evaluation time (range, 2.6 to 11.4 hours) by multiple linear regression analysis: time from arrival until bleeding time completed (P < .005), time from arrangement of computed head tomography until its completion (P < .05), chosen site of treatment (ED v neurological step-down unit; P < .005), order of patient entry P < .01), and time from arrival until completion of fibrinogen level assay (P < .05). These results emphasize the need to coordinate and stream-line the clinical evaluation process. The use of the ED as the site of treatment, abbreviating the time until pharmacologic therapy, has not been previously documented. Expedient completion of an evaluation compatible with safe pharmacologic therapy of acute ischemic stroke will dictate the time of definitive therapy. These results should assist other institutions considering rapid pharmacologic therapy for acute ischemic stroke.

Original languageEnglish (US)
Pages (from-to)11-15
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume7
Issue number1
DOIs
StatePublished - 1989
Externally publishedYes

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Keywords

  • ED treatment of thromboembolic stroke
  • pharmacologic therapy
  • Stroke
  • thromboembolic stroke
  • thrombolytic therapy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Timerding, B. L., Barsan, W. G., Hedges, J. R., Brott, T. G., VanLigten, P. F., Spilker, J. A., & Olinger, C. P. (1989). Stroke patient evaluation in the emergency department before pharmacologic therapy. American Journal of Emergency Medicine, 7(1), 11-15. https://doi.org/10.1016/0735-6757(89)90076-4