bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP294: Does The Aspirin Response Test Help Determine Whether Patients Should Receive Platelet Transfusion After Intracerebral Hemorrhage?
Authors: Horev Anat , Haber Einat , Borenstein Natan M , Koehler Steven A , Jadhav Ashutosh P , Jovin Tudor G , Linares Guillermo , Reddy Vivek K
Published: March 2022

.

Background:
Platelet transfusion for the reversal of aspirin therapy is often used in an effort to minimize hematoma expansion following intracerebral hemorrhage (ICH). We investigated whether, in patients taking Aspirin, the Aspirin Response Test (ART) is a useful predictor of hematoma expansion, in order to identify a subset of patients who would benefit from platelet transfusion. We hypothesized that patients with platelet dysfunction (ART <550) will have an ICH expansion without the transfusion, and those with normal platelet function (ART >550) will not.

Methods:
In this IRB approved, retrospective cohort analysis, we reviewed patients presenting to our institution between May 2009 and June 2012 with acute ICH. We only include cases where only aspirin and no other antithrombotic was used prior to the ICH. ICH was measured with the ABC/2 formula, on head CT in the Emergency Department and again within the first 24 hours.

Results:
We analyzed 45 patients, 30 (66.67%) of whom had documented aspirin use, and 15 (33.33%) had suspected aspirin use with ART indicative of platelet dysfunction. There were 19 patients who did not receive a platelet transfusion: of these, 18 had platelet dysfunction by ART, and 4 (22%) had hemorrhage expansion; 1 had no platelet dysfunction by ART but had hematoma expansion. The small size of the latter group prevented useful statistical analysis. In total, there were 42 patients with platelet dysfunction: of these, 18 did not get a platelet transfusion and 4 of the 18 (22%) had hemorrhage expansion. 24 did get a platelet transfusion, and 11/24 (45.8%) had hemorrhage expansion. The difference in expansion rates was not statistically significant (p=0.19).

Conclusions:
In this group, having an abnormal ART did not seem to predict hemorrhage expansion, and did not predict response to platelet transfusion. A larger, prospective study would better characterize the clinical utility of ART in patients with ICH.
Abstract TP298: Acute Intracerebral Hemorrhage: Prospective Evaluation ofaA Pragmatic Stepwise Diagnostic Algorithm for Underlying Vascular Pathologies
Authors: Schneble H M , Reiner P , Guichard J P , Bresson D , Chabriat H , Stapf C
Published: March 2022

BACKGROUND:
Intracerebral hemorrhage (ICH) is one of the deadliest form of stroke, but the diagnostic work-up has only been insufficiently defined. We tested the unsefulness of a pragmatic step-wise diagnostic algorithm including CT/CTA, MRI/MRA, and digital subtraction angiography (DSA) on the detection of acutely treatment-relevant underlying pathologies.

PATIENTS AND METHODS:
We analyzed 114 consecutive patients (42% women, mean age 66 years +/-12) hospitalized for spontaneous ICH. All patients had initial CT with or without CTA. Those without evident underlying cause and no contraindication underwent MRI/MRA. Finally, diagnostic DSA was performed in cases without evident ICH etiology on prior imaging.

RESULTS:
Of the 114 ICH patients, 2 showed deep ICH with CT evidence of severe small vessel disease. In 2 cases, CTA revealed cerebral venous thrombosis. The remaining 107 (95%) patients without contraindication (n=2 had a pacemaker) underwent subsequent MRI/MRA allowing detection of underlying small vessel disease in 36 (32%) and 14 (12%) with acutely treatment relevant pathology: one cerebral venous thrombosis, six secondary hemorrhagic infarcts, three cavernous malformations, two brain tumors, and two patients had reversible acute vasoconstriction syndrome. Fifty-seven patients (50%) remained without diagnosis of any underlying pathology and underwent DSA revealing 2 dural arteriovenous fistula, 2 arteriovenous malformation, 1 moyamoya syndrome, 1 ruptured aneurysm, and 1 acute cerebral vasoconstriction syndrome.

CONCLUSION:
Our findings suggest the diagnostic sensitivity of brain CT alone is insufficient for the diagnostic work-up in ICH patients. A pragmatic, stepwise imaging algorithm based on additional CTA, MRI/MRA and DSA lead to the diagnosis of an underlying pathology in 52%, including the detection of acutely treatment-relevant pathologies in 19% (22 of 114 patients).
Abstract TP303: Gender Differences in the Use of Early Do-Not-Resuscitate Orders after Intracerebral Hemorrhage
Authors: Nakagawa Kazuma , Vento Megan A , Seto Todd B , Koenig Matthew A , Asai Susan M , Chang Cherylee W , Hemphill J C
Published: March 2022

Background and Purpose:
Studies show that women are more likely to receive do-not-resuscitate (DNR) orders after acute medical illnesses than men. However, the gender differences in the use of early (<24 hours of presentation) DNR order after acute intracerebral hemorrhage (ICH) has not been described.

Methods:
We conducted a retrospective study of consecutive patients hospitalized for acute ICH at a tertiary stroke center between 2006 and 2010. Unadjusted and multivariable logistic regression analyses were used to test for associations between female gender and early DNR orders (<24 hours of presentation).

Results:
A total of 373 consecutive ICH patients without pre-existing DNR orders (NHPI 19%, Asians 62%, non-Hispanic whites 15% and other 4%) were studied. Unadjusted analysis showed that women were more likely to receive early DNR orders compared to men (odds ratio 2.26, 95% CI 1.37 to 3.72). In the fully adjusted model, the independent predictors of early DNR orders were female gender (odds ratio 3.21, 95% CI 1.52 to 6.78), age (odds ratio 1.08 per year, 95% CI 1.05 to 1.11), ICH volume (odds ratio 1.02 per cm3, 95% CI 1.01 to 1.03), initial GCS score (odds ratio 0.74 per point, 95% CI 0.66 to 0.82) and whether the patient was transferred from another hospital (odds ratio 0.28, 95% 0.11 to 0.76). When comparing gender-related outcome, mortality was not different between women and men (25% vs. 27%, p = 0.71).

Conclusions:
Women are more likely to receive early DNR orders after ICH than men. Further prospective study is needed to determine factors contributing to the gender variation in the use of early DNR order after ICH and whether this variation represents differences in patient preferences or preferences of the surrogate decision-makers.
Abstract TP305: Lower Serum Total Cholesterol Levels Are Associated With Increased Severity of Intracerebral Hemorrhage: Results from the Taiwan Stroke Registry
Authors: Chen Yu-Wei , Tseng Mei-Chiun , Jeng Jiann-Shing ,   Taiwan Stroke Registry
Published: March 2022

Background and Purpose:
Evidence of a causal relationship between serum cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that lower total serum cholesterol (TC) levels are associated with severe intracerebral hemorrhage (ICH).

Methods:
During May, 2006 and April, 2009, patients registered in the Taiwan Stroke Registry, a prospective registry engaging 38 academic and community hospitals across Taiwan (Hsie FI et al, Circulation, 2010), and who had first-ever spontaneous ICH were included. Patients who did not have measure of TC at baseline were excluded. Lower TC was defined as the serum level of TC <160 mg/dl. Stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS) was dichotomized (score >15 versus ≤15). Mortality and poor functional outcome (modified Rankin Scale score >2) at 1 month were collected. Multivariable logistic regression analysis was used to determine the association between lower TC and initial severity of ICH.

Results:
A total of 2239 ICH patients (mean age 62±14 years, 64% men) were included in this analysis. There were 774 (34.6%) patients presented with lower TC on admission. Lower TC levels at baseline was significantly associated with higher baseline NIHSS >15 (odds ratio, 1.78; 95% CI, 1.44 to 2.19). One-month case-fatality was higher in patients with low TC than those without (9.2% vs. 5.1%, P=0.0002). Prior use of lipid-lowering drugs was not associated with low TC or not.

Conclusion:
A lower total cholesterol level was associated with increased severity of ICH at presentation.
Abstract TP311: A Safe Early Mobility Protocol for Stroke Patients
Authors: Yanase Lisa R , Baraban Elizabeth , Stuchiner Tamela L , McBride Ashley , Walker Deborah
Published: March 2022

Background:
Early mobilization of medical and critical care patients benefits outcome, length of stay, and patient satisfaction. There is limited data regarding safety of early mobilization of stroke patients, because concern for falls or neurologic deterioration due to positional hypoperfusion has led to promoting bed rest during the acute phase of care. The study evaluated the ability of nursing staff to safely assess and mobilize stroke patients at an appropriate level within 24 hours of admit.

Methods:
A Stroke Mobility Protocol was developed to assess the clinical readiness of patients to be mobilized. The protocol was implemented in January 2011 for all stroke patients in our neurosciences unit. Protocol safety was evaluated by the number of persistent clinical deteriorations, falls occurring due to the protocol and the overall fall rate. Nurses were to monitor for clinical decline and report any changes not resolving after repositioning. Falls in patients with a stroke diagnosis were tracked using unusual occurrence reports. Fall rates were calculated as number of falls per 1,000 patient days. Post-implementation fall rate from 2011 was compared to pre-implementation falls rate from 2010. Our 2011 fall rate was also compared to 2011 fall rate of an affiliated hospital not using the protocol. Fall rates were compared using the Wilcoxon Rank Sum Test.

Results:
There were no reports of persistent neurologic deterioration. The post-implementation fall rate per 1,000 patient days was lower (1.4 falls, mean rank=408.00, n=436) compared to the pre-implementation rate (6.3 falls, mean rank=405.21, n=376) although these differences were not statistically significant (p=.38). The 2011 fall rate at the comparable hospital (5.1 falls, n=590) was also higher compared to the protocol hospital, although not statistically significant (mean ranks: 516.31 versus 509.69, respectively, p=.11). No falls occurred as a result of the protocol.

Conclusions:
Initial data indicate that early mobilization does not lead to prolonged neurologic deterioration or more falls. The Stroke Mobility protocol enables nurses to safely evaluate patients’ function, allowing earlier mobilization.
Abstract TP314: Moderate-High Intensity Exercise Training Improves Submaximal and Peak Cardiorespiratory Response in Sub-acute Stroke
Authors: Billinger Sandra A , Mattlage Anna E , Lentz Angela A , Ashenden Abigail L , Rippee Michael A
Published: March 2022

Purpose:
Limited research is available for exercise prescription during the subacute stage of stroke recovery. Peak and submaximal cardiorespiratory response during exercise testing in sub-acute stroke has also not been extensively studied. We assessed the hypothesis that an eight-week aerobic exercise intervention at moderate-high intensity would improve cardiorespiratory response during submaximal and peak effort in sub-acute stroke.

Methods:
Ten individuals (68.6+40.1 days post-stroke) enrolled in the study and 9 participants completed the exercise intervention. The nine participants were 61.2+4.7 years of age with a total Fugl-Meyer score, 102.2+30.4. Peak exercise testing was done at baseline and post-intervention to assess oxygen consumption (VO2), HR and minute ventilation (VE). A seated stepper was the mode of exercise with exercise intensity at 50-59% of HR reserve (first 4 weeks) and then increased to 60-69% of HR reserve for the last 4 weeks. Paired t-tests were used to assess differences at peak effort. Submaximal performance on the exercise test was assessed using an analysis of variance, with Test Minute (minutes 1-6) and Study Visit (baseline, post-exercise) as within subject factors. P-values < 0.05 were considered statistically significant.

Results:
At peak effort, VO2, HR and VE were higher post-intervention but only VO2 peak was statistically significant. During submaximal effort, we found VO2 and HR to be lower after the exercise intervention. For VO2 there was no interaction (F5,40=0.95, p=0.40) between Study Visit and Test Minute but we report a main effect of Study Visit (F1,8=8.5, p=0.02). There was not a significant interaction for HR between Study Visit and Test Minute (F5,40=0.28, p=0.92). Nor was there a main effect of Study Visit (F1,8=2.7, p=0.14). VE increased similarly across Test Minute and Study Visits. No interaction of Study Visit and Test Minute were evident nor was there a main effect of Study Visit.

Conclusion:
This preliminary data demonstrates that an 8-week aerobic exercise intervention shows promise for improving peak and submaximal cardiorespiratory response in sub-acute stroke.
Abstract TP334: Implementing an Early Mobility Protocol on a Stroke Unit
Authors: Sawyer Leslie , Boyd Donna , McBride Ashley , Walker Deborah , Yanase Lisa
Published: March 2022

Background and Issues:
ASA guidelines support early mobilization of less severely affected stroke patients, with bedrest until they are clinically stable. However, there is no standard for assessing clinical stability of patients regardless of severity. Also, therapy resources may be limited, delaying mobility even in appropriate patients.

Purpose:
Our goal was to develop, implement, and assess a protocol for nursing staff to assess mobility readiness and advance activity in all stroke patients, within hours of admission.

Methods:
Stroke nurses, occupational/physical therapists (OT/PT), and a stroke neurologist, teamed to review mobility literature, then develop an assessment protocol with progressive, monitored levels of activity, usable by nursing and OT/PT. Barriers to implementation were identified and overcome. Adherence to protocol was audited by chart review. Safety was monitored via unusual occurrence reports. Nursing satisfaction was assessed by verbal feedback.

Results:
A progressive mobility assessment protocol was developed with staff feedback. Identified obstacles to implementation included: staff protocol awareness, mobility assessment inexperience, work routine alteration, patient safety concern, and lack of a charting system. Educational in-services, posters, emails, and one-on-one training emphasized expected benefits of the program for patients and staff. Meal vouchers were offered as rewards for compliance. Compliance was 18% with a paper charting form, but improved to 85-100% with a revised computer charting system. Patient safety was not compromised, and nursing workflow improved with earlier patient mobilization. Therapists are able to build on previous nursing assessments, enhancing efficiency. Nursing participation in protocol development promoted ownership of the protocol, based on verbal feedback.

Conclusion:
Our inter-disciplinary team successfully developed and safely implemented a new mobility practice protocol. This protocol benefits patients, nursing and rehab teams allowing safe and expedited patient activity, and improving efficiency on the stroke unit.
Abstract TP338: Process Improvement Retrospective Review: Hyperglycemia Treatment after Stroke and Subsequent Hypoglycemia
Authors: van Groos Kimberly
Published: March 2022

Background and Purpose:
Admission blood glucose in stroke patients has been proven to be an independent predictor of disability and short term mortality. Hyperglycemia has been shown to have an association with infarct volume expansion in ischemic stroke patients. Euglycemia is often achieved through the use of an intravenous insulin drip. Current guidelines caution against the use of D5W as the excess free water may exacerbate cerebral edema; rather, normal saline is preferred. The use of IV insulin with normal saline or other non-dextrose containing IV fluids without enteral nutrition has been the subject of concern for increased hypoglycemic episodes.

Methods:
Single center review of all patients admitted for all types acute stroke from May 1
st
, 2011 to April 27
th
, 2012 who were subsequently placed on an IV insulin drip at any time during hospitalization (n=97). Retrospective review of all hypoglycemic episodes (<70mg/dL), IV maintenance fluids, and nutrition (tube feeding, oral diet, TPN) during the course of hospitalization was conducted.

Results:
A total of 97 stroke patients on IV insulin were identified; 20 (20.6%) were excluded due to alternately receiving dextrose and non-dextrose containing fluids; 65 (67%) did not receive any IV fluids containing dextrose while on IV insulin; 12 (12.4%) did receive IV fluids containing dextrose. The number of patients who experienced hypoglycemia was not significantly different between groups [5 (7.7%) vs. 0 (0%), p=1.000]. In the 5 patients with hypoglycemic episodes 4 were receiving enteral feeding during these episodes; only 1 patient in the sample (1.3%) was on neither IV dextrose nor enteral nutrition during a hypoglycemic episode.

Conclusions:
Post-stroke hyperglycemia is safely controlled by IV insulin and non-dextrose containing solutions without significant risk for hypoglycemic episodes.
Abstract TP344: Does Stroke Education Including Post Discharge Telephone Support Improve Stroke Recognition And Need To Call 911?
Authors: Ballard Kimberly A , Carmany Kelly , Hazelett Sue
Published: March 2022

Background and Purpose:
Due to short hospital stays and fragmented education attempts, inpatient stroke education can be inadequate. The purpose of this randomized feasibility study was to determine if an enhanced inpatient/post discharge telephonic stroke education strategy improved patient recognition of signs and symptoms of stroke and the need to call 911 compared to usual stroke unit education by staff nurses.

Methods:
This pilot study consisted of 25 stroke or TIA inpatients discharged to home, who were randomly assigned to an intervention or usual care group. Of the 18 patients with complete data, 9 were intervention and 9 were control patients. The educational intervention included a sit-down, in-patient, formalized education session, encouraging family/significant other involvement, a 30 day follow-up phone call, and 60 day educational mailings. Usual care education involved a stroke education booklet and variable verbal instruction by staff nurses. All patients received a 90 day telephone call to evaluate outcomes.

Results:
An average time of 27 minutes was spent on education with intervention patients. Stroke symptoms such as trouble speaking, numbness, tingling and weakness were correctly identified by both groups 95-100% of the time. Dizziness and loss of balance were also correctly identified by 95% of participants. Additionally 95% of participants said they would call 911 with stroke symptom onset; whereas, only 56% of the patients originally arrived on site via EMS.

Conclusions:
Staff nurse education on stroke units is highly effective. The control group retained as much information as the intervention group at 90 days post discharge, leaving little to no room for improvement by enhanced education. These data indicate that the inpatient stroke education was sufficient to ensure recognition of signs and symptoms of stroke and the need to call 911 90 days post discharge. Further research is necessary to determine the effectiveness of stroke education provided by community education initiatives and the media, as well as its effects on lifestyle modifications.
Abstract TP351: A Collaborative Approach to Emergency Medical Service Stroke Training
Authors: Price Theresa M , Worden Eileen , Mitchell Marylou , Bergman Karen , Zinmaster Jaime , Connors Teri , Chernauckas Kerri , Godfrey Andrea , Glaza Kathleen , Lull Debbie
Published: March 2022

Background:
The prevalence of stroke is expected to increase. Emergency Medical Service (EMS) personnel play a critical role in the chain of survival for stroke with more than half of stroke patients utilizing EMS to access initial medical care. National guidelines recommend EMS educational programs with objectives that support steps considered critical for the use of time dependent therapies. Value Health Partners (VHP), an unique quality collaboration between seven nonaffiliated hospitals with a combined annual stroke admission volume of 2,756 and service covering 44 of the 81 Michigan counties, has developed a strategy to bring Advanced Stroke Life Support (ASLS)
®
training to their service areas. The curriculum targets National guideline objectives using interactive discussion, hands on demonstration and is designed in a train the trainer format.

Purpose:
The purpose of this collaborative quality project is to utilize validated curriculum to improve and standardize pre-hospital care for patients with stroke symptoms within a large reach of Michigan communities.

Methods:
Stroke clinical leaders from VHP met to coordinate the initiative with Michigan Department of Community Health and EMS. A grant to underwrite the cost of implementing the curriculum was written and accepted. Leaders collaborated on the development of a training schedule, implementation guide, advertising and registration process. Metrics were identified for future project impact analysis. Grant funds were allocated and a registration fee was identified as a strategy for securing future implementation funds.

Results:
The collaboration and development of an implementation process among nonaffiliated hospitals established standardized training for EMS on pre-hospital stroke care which when completed will cover more than half of the state.

Conclusions:
Nonaffiliated hospital and state level quality collaborations encourage networking, support standardization of best practice processes within a state and provide a potential significant impact on the health of the communities we serve.
Abstract TP356: Three Tales: Intravenous Tissue Plasminogen Activator Treatment of Acute Ischemic Stroke in Patients with Compressible Procedure Sites.
Authors: O’Brien Suzanne L , Buckle Brenda S , Tummala Sunita
Published: March 2022

Background:
Stroke is the most frequent neurological disorder and common cause of severe disability compared to other diseases. Intravenous thrombolytic therapy with tissue plasminogen activator (IV t-PA) within 3 hours is currently the standard for treating ischemic stroke patients. Major surgery within the prior three months of acute stroke is contraindicated for IV t-PA. Utilizing the AHA/ASA stroke database “Get With The Guidelines,” we identified three patients given IV t-PA with compressible procedure sites. The complexity of these three unique hospitalized in-patient cases necessitated a collaborative team approach.

Purpose:
The aim of this study was to review the initial nursing strategies and stroke team collaboration in administering IV t-PA with compressible procedure sites. Little research has been published on the incidence of patients receiving IV t-PA with compressible procedure sites and potential risk of treatment in this population, therefore identifying a gap in the literature.

Methods:
A retrospective chart review between December 2011 and February 2012 was completed identifying three hospitalized patients with acute onset ischemic stroke who received IV t-PA with compressible procedure sites. Four bedside assessment strategies were identified, 1) Initial Neurological Changes, 2) Activation of Stroke Team, 3) NIHSS Score and 4) Neurology Consultation. Rapid assessment by the stroke team of hospitalized patients with acute neurological change is critical in stroke care.

Results:
Three of 32 hospitalized patients received IV t-PA with compressible procedure sites. Initial NIHSS scores ranged from 19 to 24, post NIHSS scores ranged from 4 to 14, resulting in no deaths. Similarities reflect discharge orders on chart, onset 09:00 - 12:00, permanent pacemaker, normal INR, mean blood glucose 120mg/dl. Discussion among team members was essential in the decision to administer IV t-PA with compressible sites; significantly reducing neuro disability.

Conclusion:
A collaborative team approach in these three complex acute stroke patients demonstrated significant critical decision making in confirming IV t-PA administration and outcomes.
Abstract TP359: One Patient, One Standard, One Medical Record: Improving Documentation of t-PA Therapy across the Care Continuum
Authors: Long Jeanne , Bailey Ruth
Published: March 2022

Background and Issues:
Department specific documentation systems resulted in a non-standardized approach to assessment documentation for patients receiving intravenous t-PA for treatment of acute stroke. Subsequently, compliance with documentation requirements during transition of care from the emergency department (ED) to intensive care unit (ICU) did not meet targeted benchmarks.

Purpose:
Design a hospital-wide standard and system for vital signs and neuro assessment documentation for patients receiving IV t-PA for the treatment of acute stroke.

Methods:
A multidisciplinary team analyzed current practice and collaborated to create one standardized documentation record that would satisfy requirements for the ED and the ICU. A t-PA worksheet had proven success with physicians for documenting eligibility and ordering t-PA. The team agreed to keep this worksheet as page one of the documentation record. Page two was designed for ED documentation of medications, assessments and patient response. Page three captures the documentation of mandatory vital signs and neuro assessments. The Stroke Leadership committee approved recommendations from this team for nurses to assess patients using the abbreviated NIH Stroke Scale. Prior to implementation, Physicians and Nurses received education regarding the abbreviated stroke scale and expected documentation.

Results:
Concurrent monitoring for compliance in documentation of post t-PA vital signs and neuro assessments began with the implementation of this revised documentation record. First month post implementation reported 95% compliance rate and 100% by the fourth month.

Conclusions:
Process standardization with one consistent documentation tool has sustained 99-100% compliance in documentation of assessments pre and post t-PA administration.
Abstract TP36: Novel Imaging Technique For Evaluation of Carotid Stenosis Using MRI with 3D Fast- Spin- Echo
Authors: Kan Issei , Ishibashi Toshihiro , Shibuya Kazunori , Kitagawa Hisashi , Kaito Nobuki , Murayama Yuichi , Abe Toshiaki
Published: March 2022

[Purpose]
Multi-modalities, such as carotid ultrasound, MRI for plaque imaging, CT angiography (CTA), and angiography, have been utilized for diagnosis of carotid artery stenosis. However, we encounter a situation that high cervical internal carotid artery stenosis makes carotid ultrasound difficult, and a situation that renal dysfunction restricts the use of contrast agent for aforementioned angiography. In evaluation of carotid stenosis, we have recently performed 3D Fast-Spin-Echo MRI (CUBE®, GE medical, USA) with modified sequence, which is completely non-contrast image, and we compared the results from CUBE with modified sequence with that from CTA.

[Materials and Methods]
Five patients with carotid stenosis underwent both CTA and CUBE with modified sequence. Sequence was optimized to be black as long as the vessel lumen visualization is possible. Images taken with both modalities were processed on 3D workstation (Ziostation, Amin, Japan), and stenosis rate was determined with North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria.

[Results]
Optimized Sequence is as following: TR 600msec, efTE 13.9msec, BW 62.5kHz, ETL 10, NEX 0.5, matrix 256 × 256, slice thickness 0.8mm, scan time 8:29, FOV 21 × 21cm. Each stenosis rate in the CTA group was 42.2%, 37.5%, 27.3%, 21.6%, and 53.8%. On the other hand, each stenosis rate in the CUBE with modified sequence was 43.5%, 40.8%, 23.6%, 24%, and 19%. Average difference between two modalities among five cases was 2.3% (1.3-3.7%).

[Discussion and Conclusion]
The results obtained from the CUBE with modified sequence shows similar stenosis rate to that obtained from the CTA. Moreover, yet non-contrast imaging, the vascular lumen was well delineated without being affected by metal artifacts and calcification. This result suggests that CUBE with modified sequence is useful as one of evaluation method for patients with carotid stenosis in addition to conventional modalities.
Abstract TP37: Prediction of Outcome in Cerebellar Infarction by Diffusion MRI
Authors: Tchopev Zahari , Hiller Marc , Betz Josh , Zhuo Jiachen , Gullapalli Rao , Sheth Kevin N
Published: March 2022

Background and Purpose —
Early identification of patients at risk for neurological deterioration due to edema after stroke remains a challenge. MRI based volumetric assessments of infarct have been shown to predict poor outcome amongst patients with large middle cerebral artery infarcts. However, no such quantitative imaging measure exists to predict outcome following cerebellar stroke. In this study, we tested the hypothesis that volumetric assessment of cerebellar infarcts can provide reliable information for the prediction of neurological deterioration.

Methods —
We retrospectively identified forty-four consecutive subjects (age 55.2±13) with cerebellar stroke who underwent MRI with DWI (mean 63.7 hours). Subjects were divided into poor (n=13) and good outcomes (n=31). Subjects were classified in the poor outcome group according to at least one of the following criteria: (1) mortality (2) decompressive craniectomy (3) ventriculostomy (4) decrease of consciousness according to item 1a of the NIH stroke scale score (NIHSS). These poor outcomes represent mass effect of the cerebellar infarct. Lesion and cerebellar volume were defined on ADC maps. The ratio of the lesion volume to the whole cerebellum volume was calculated (rVolume). The predictive value of volume and rVolume was determined using ROC analysis.

Results —
Logistic regression revealed that rVolume was associated with increased risk of poor outcome, even after adjusting for age and NIHSS (χ2 =9.4449, p < 0.0022). The logistic regression model with age, rVolume, and NIHSS achieved an AUC of 0.816 (95% CI: 0.678-0.955), while a regression model with age and NIHSS alone achieved an AUC of 0.711 (95% CI: 0.537-0.885). The difference in AUC between these models was not statistically significant (Z = 0.3816, p = NS).

Conclusions —
Quantitative measurement of rVolume predicts poor outcome of cerebellar stroke patients, even when controlling for age and NIHSS. Quantitative analysis of diffusion MRI may assist in identification of patients with cerebellar stroke at highest risk of life-threatening edema. Prospective validation is warranted.
Abstract TP370: Tai Chi and SilverSneakers® Interventions Improve Aerobic Endurance in Older Stroke Survivors
Authors: Taylor-Piliae Ruth E , Hepworth Joseph T , Latt L D , Coull Bruce M
Published: March 2022

Background:
Physical activity reduces recurrent stroke risk, yet suitable community-based programs are lacking. Tai Chi (TC) and SilverSneakers® (SS) can be easily adapted for persons with disabilities. TC integrates physical movements with mindfulness, while SS focuses on strength and range of movement.

Purpose:
To examine the effects of TC and SS interventions on physical functioning compared to Usual Care (UC).

Methods:
A randomized trial was conducted among stroke survivors (n=145), aged ≥ 50 years, and at ≥ 3 months post-stroke (TC, n=53; SS, n=44; or UC, n=48). TC and SS groups attended a 1-hour class 3X/week for 12 weeks. The UC group received a weekly phone call along with written materials for participating in community-based physical activity. The Short Physical Performance Battery (SPPB) assessed balance, gait speed, and lower body strength; a two-minute step-in-place test (StepTest) assessed aerobic endurance. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) assessed amount of self-reported physical activity. Clinically meaningful changes in SPPB (small=0.5 points, substantial=1.0 points), and gait speed (small=0.05 m/sec, substantial=0.10 m/sec) were examined. Data were analyzed using 2 (time) X 3 (group) ANOVAs.

Results:
Subjects (47% women) were on average 70±10 years old, and 37±48 months post-stroke. The majority were married (58%), White (79%), college educated (79%), retired (80%), reporting an ischemic stroke (66%) with hemiparesis (73%). All groups reported a similar amount of physical activity (PASIPD=14.8±11.0 MET hrs/day, F
2,142
=1.04, p=0.36); and had substantial improvements in SPPB score (F
1,142
=85.29, p<0.01), with small improvements in gait speed (F
1,142
=25.97, p<0.01). There was a significant group by time interaction for the StepTest (F
2,142
=4.69, p<0.01); TC (t
53
=2.45, p=0.02) and SS (t
44
=4.63, p<0.01) had significantly better aerobic endurance over time, while this was not observed in the UC group (t
48
=1.58, p=0.12).

Conclusions:
A goal of stroke rehabilitation is to prevent disability and declines in physical functioning. TC and SS improved aerobic endurance, and both are suitable community-based programs that may aid in stroke recovery and community reintegration.
Abstract TP375: Delivering Comprehensive Stroke Services can be Financially Beneficial to a Community Hospital
Authors: Santos Patricia , Roper Debbie , Guthmann Anita , Coulson Jeff , Whitley Mark , Janardhan Vallabh
Published: March 2022

Background and Purpose:
Primary Stroke Centers may be reluctant to develop capabilities to deliver comprehensive stroke services due to the cost of investing in physicians, staff and technology. Additional factors influencing administrators’ decision to pursue comprehensive stroke care include reimbursement rates, increasing numbers of uninsured patients, and local competition. The purpose of this study was to determine the financial benefit to both a single community hospital and to its sister facilities within the same healthcare system, by comparing performance before and after initiating comprehensive stroke care.

Methods:
Financial data was analyzed from two 2-year periods, one before and one after comprehensive stroke care services were launched at one of nine community-based hospitals within a community hospital system.

Results:
The number of admissions for all cerebrovascular diagnosis (ICD9 430-438) increased by 88% at the comprehensive site and 5.6% in the other combined system hospitals, in the two year period after advanced stroke care was introduced. Earnings before interest, taxes, depreciation, and amortization (EBITDA) per case, an indication of operational profitability, rose from a negative to a positive value at the comprehensive site hospital. The combined mean contribution margin (CM) per admission increased by 62%. Quality indicators were maintained or improved during this transition.

Conclusion:
This study showed that a Primary Stroke Center that was previously experiencing losses per stroke admission gained a significant benefit in profitability and income after converting to comprehensive services. By launching the program as part of a network of care, the system also experienced an overall benefit as evidenced by a market share gain in cerebrovascular care from 20.21% to 23.49%.
Abstract TP378: Statin Use among Patients with Intracerebral Hemorrhage in the Paul Coverdell National Acute Stroke Registry
Authors: George Mary G , Tong Xin
Published: March 2022

Background:
Various studies have produced conflicting results on whether statins increase the risk of intracerebral hemorrhage (ICH) yet many studies show a protective effect for those on statins at the time of acute ischemic stroke (AIS). This study assesses the characteristics and outcomes of patients having intracerebral hemorrhage and statin use in the Paul Coverdell National Acute Stroke Registry (PCNASR).

Methods:
There were 103,491patients with AIS and 16,319 with ICH enrolled in the PCNASR during 2009-2011. Chi-square tests were used to test for association of clinical characteristics with ICH and ICH with statin use. Logistic regression analysis was used to assess factors associated with odds of ICH vs. AIS and mortality among ICH patients.

Results:
Of 16,319 patients with ICH, 5,522 were on statins at the time of ICH (33.8%). Among ICH patients, mean age was 72.8 for statin users (S) and 65.3 for non-statin users (NS) (p<0.0001). Median NIHSS score was 7 for ICH on S and 9 for ICH among NS (p=0.002). Mean LDL cholesterol was 101 among ICH and 102 among AIS (p=0.28). Statin use was associated with less ICH (AOR 0.82, CI 0.79, 0.85). Statin users with ICH had higher prevalence of hypertension, atrial fibrillation, ischemic heart disease, heart failure, diabetes, carotid stenosis, cardiac valve prosthesis, taking antithrombotics, antihypertensives, or prior stroke compared to NS with ICH (p<0.0001 for all). Among ICH patients, adjusted analyses showed males, older age, NIHSS score, cardiac valve prosthesis (CVP) and antithrombotic use were associated with increased in-hospital mortality, while statin use was not associated with in-hospital mortality (AOR 0.97, CI 0.80,1.16) (Table).

Conclusions:
Mortality among patients with ICH was greatest among those with CVP or on antithrombotics. Statin use was associated with less severe ICH, but not with ICH in-hospital mortality.
Abstract TP385: Diastolic Function Of Heart And Outcomes After Ischemic Stroke
Authors: Ryu Wi-Sun , Kim Chi Kyung , Oh Mi-Young , Kim Chang-Heon , Kim Min-Jeong , Lee Seung-Hoon , Yoon Byung-Woo
Published: March 2022

Background:
Diastolic dysfunction (DD) has recently been shown to be a predictor of all-cause mortality in general population. Venticular stiffening and impaired relaxation are major pathophysiology of DD, and thus the patients with DD encounter exercise intolerance. We therefore hypothesized that the patients with DD are likely to have unfavorable outcome after ischemic stroke.

Method:
We analyzed 503 consecutive ischemic stroke patients who underwent tissue Doppler echocardiography. DD profiles were consisted of peak mitral inflow velocity/mitral A-wave velocity, mitral deceleration time and peak mitral inflow velocity/diastolic tissue velocity (E/E’). Modified Rankin scale at 3months after stroke was used as a functional outcome. We performed logistic regression to examine the independent associations between DD profiles and outcomes. For sensitivity analyses, we reran regression in the settings of exclusion of patients with AF, exclusion of patients with previous stroke and exclusion of patients with coronary heart disease.

Results:
The patients with unfavorable outcome had a greater E/E’ [dichotomized, favorable(n=390) vs. unfavorable(n=113), 11.0±4.6 vs. 16.4±7.9, p<0.001; responder analysis-defined outcome, favorable(n=240) vs. unfavorable(n=263), 10.6±3.3 vs. 13.7±7.4, p<0.001] In multivariable analyses, E/E’ was independently associated with responder-analyses defined unfavorable outcome. Dividing into quartile, the adjusted odd ratio(OR) for unfavorable outcome of the fourth quartile was 2.97[95% confidence interval(CI),
1.61.5.48
] compared with the first quartile. When Q1-Q3 were collapsed as a single reference, adjusted OR of Q4 was 2.97(1.76-5.02). When we used a dichotomous outcome, this relationship became more robust. After dividing the patients according to the subtype of ischemic stroke, this relationship is consistent except for other-determined etiology; Q1-Q3 vs. Q4 adjusted OR ranged from 2.23 to 6.16. In sensitivity analyses, the impact of E/E’ on stroke outcome was materially unchanged.

Conclusion:
Because E/E’ is best correlated with invasively-assessed diastolic function, our results suggested that diastolic dysfunction may hinder a functional regain following ischemic stroke.
Abstract TP388: Timing Of Diagnosis Of Atrial Fibrillation Relative To Ischemic Stroke And Transient Ischemic Attack
Authors: Wiederkehr Daniel , Mardekian Jack , Dietrich Flavia , Petkun William , Tan Wilson , Cater Nilo
Published: March 2022

OBJECTIVES:
To determine the frequency of initial atrial fibrillation (AF) diagnosis prior to, concurrent with, or subsequent to incident ischemic stroke and ischemic stroke or transient ischemic attack (TIA).

METHODS:
A large healthcare claims database (MarketScan) was queried to identify adult patients with an inpatient diagnosis of ischemic stroke between 2004 and 2010. Inpatient or outpatient diagnoses of AF were identified on claims prior to hospitalization admission for stroke, during the hospital stay, or following discharge. Stroke patients were categorized as to whether initial AF diagnosis occurred prior, concurrent, or subsequent to stroke or diagnosis was never made. Restrictions on minimum health plan pre-enrollment prior to incident stroke were applied for sensitivity analysis of estimates of patients diagnosed with AF. Additional estimates of prior, concurrent and subsequent initial AF diagnosis were performed for patients with either incident inpatient stroke/TIA or outpatient TIA diagnosis.

RESULTS:
Of the 303,555 patients identified with an inpatient diagnosis of stroke and 795,612 patients with either inpatient stroke/TIA or outpatient TIA, 48.4% and 45.1% were male, respectively. Average ages were 68.2 (SD 15.8) and 66.1 (SD 15.6), respectively. The majority of patients never had a diagnosis of AF; a minority had a concurrent diagnosis, while a larger percentage had a subsequent diagnosis (Table).

CONCLUSIONS:
A proportion of the 12.4% of stroke and 8.9% of stroke/TIA patients with concurrent or subsequent AF diagnosis may have had undetected / paroxysmal AF at the incident stroke or TIA. Concurrent AF diagnoses alone may underestimate the percentage of patients with undetected AF at the time of stroke or TIA. More aggressive efforts to diagnose AF may be beneficial, although additional research is needed to better quantify the current burden of undiagnosed AF among stroke patients.
Abstract TP391: Predictors of Discharge Location and Long-Term Living Destination Following Acute Care Hospitalization for Intracerebral Hemorrhage: The DECIPHER Study
Authors: German Laura , Edwards Dorothy F , Menon Ravi S , Fernandez Stephen , Shara Nawar , Gibbons M. Christopher , Trouth Anna , Kidwell Chelsea S , Boden-Albala Bernadette
Published: March 2022

Background:
The goal of this analysis was to determine factors predictive of discharge location and long-term living destination in patients following primary intracerebral hemorrhage in the DECIPHER cohort.

Methods:
DECIPHER is a longitudinal, multicenter, MRI-based, natural history study of racial differences in primary ICH. Inclusion criteria for this analysis were: primary ICH, age ≥ 18, signed informed consent, discharge data at baseline and year 1, and NIH Stroke Scale (NIHSS) at baseline. Clinical and demographic data were collected on all subjects.

Results:
There were 135 DECIPHER surviving patients who met inclusion criteria (mean age, 58 +/- 13 years; mean admission NIHSS 8 (median 5), 53% male, 76% African American). The discharge locations for subjects directly following their acute hospitalization were: 41% home, 44% acute rehabilitation, and 15% skilled nursing facility. There was no difference in discharge location by race. At year 1, 87% of subjects were at home and 13% were at a skilled nursing facility, suggesting that the patients who were discharged to acute rehab following their hospitalization were likely to be at home at the year 1 time-point. On multivariate logistic regression analysis, significant predictors of discharge to home were younger age (p=0.001), lower baseline NIHSS (p<0.001), and being married at stroke onset (p=0.001). Neither socioeconomic status nor hemorrhage volume (independent of NIHSS) entered into the predictive model. At year 1, 70% of subjects had a good functional outcome (mRS 0-2). In a predictive model of good outcome at 1 year, baseline NIHSS (p<0.001), being married at baseline (p=0.011), and age (p=0.002) were all independent predictors, however, discharge to home versus acute rehabilitation at baseline did not enter into the model.

Conclusions:
In the DECIPHER cohort of patients hospitalized with primary ICH, there were no significant racial differences in discharge destination. In addition to younger age, and lower NIHSS score, being married was significantly associated with discharge home vs. acute rehabilitation. Being married was also an independent predictor of good outcome at 1 year, highlighting the important role of social support in various aspects of stroke recovery.
Abstract TP392: Temporal Trends in Practice Patterns for Acute Ischemic Stroke Workup: A Population-Based Study
Authors: Loftspring Matthew C , Khoury Jane C , Alwell Kathleen A , Moomaw Charles J , Kleinforfer Dawn O , Flaherty Matthew L , Woo Daniel , Adeoye Opeolu , Ferioli Simona , Kissela Brett M , Broderick Joseph P , Khatri Pooja
Published: March 2022

Background:
Approximately 5%-18% of patients with ischemic strokes will have recurrent stroke within 90 days of the initial event. Establishing stroke etiology is essential to identify treatable conditions that may reduce risk of recurrence. Our objective was to determine practice patterns for the inpatient workup of acute ischemic stroke types in our population over time.

Methods:
We reviewed stroke-related diagnostic testing for first-ever hospitalized ischemic strokes among residents of the Greater Cincinnati/Northern Kentucky (GCNK) region of 1.3 million people from all 16 adult area hospitals during three one-year study periods (7/93-6/94,1999, and 2005). Seminal studies supporting assessment of the heart and extracranial vessels had been published by 1991. Therefore we defined a “complete workup” to be echocardiography and/or history of atrial fibrillation and evaluation of extracranial arteries. Risk factor screening and the frequency of less common tests were also explored.

Results:
Rates of complete workups for 1993-94, 1999, and 2005 were 50%, 58% and 74% (p<0.0001 for trend), respectively (Table 1). There was no association between stroke admission volume and rate of complete workup (r=-0.25, p=0.33; r=0.49, p=0.05; and r=0.03, p=0.90, respectively).

Conclusion:
A significant increase in the use of an evidence-based stroke workup was observed for 2005, compared with 1993-94 and 1999. It should be noted that our rates may be underestimates of appropriate testing as some may have occurred in the outpatient setting and others may have had appropriately limited testing. In the future it will be important to determine whether these rigorous, evidence-based workups translate into reduction of recurrent strokes on the population level.