bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract TP120: Hospital Finance Optimization Through AI-based Stroke Care Coordination Platform
Authors: Mullen Deborah , Sevilis Theresa , Avila Amanda , Johnson Stephen , CATALANO PETER , Devlin Thomas
Published: January 2025

Introduction:
AI-based Stroke Care Coordination Platforms (AI-SCCP) have been shown to improve patient transfer decisions and provide access to the highest quality standards of care for all patients. Since strokes happen everywhere and anytime, we examine the economic benefits of implementing AI-SCCPs for two different hospital types: CSC - a comprehensive 24/7 stroke program inclusive of endovascular surgical care and PSC - “Acute Stroke Ready” facilities with radiological imaging and thrombolytic medication treatment capacities but no endovascular surgical care and patients/families.

Methods:
Using 2021 Medicare MS-DRG payment averages, we calculate the AI-SCCP's PSC break-even point, its effects on CSC finances, and the reduced transfers' economic benefits for the patient and family.

Results:
Avoided transfers enable the PSC to continue caring for the patient locally, increasing patient volume and resulting in increases in total contribution margin and net revenues beyond the costs of the AI-SCCP. While these retained patients decrease the CSC patient transfer volume, the CSCs will still provide care to all PSC patients needing surgical interventions and patients with MS-DRGs 61-66 who arrive at their locations via initial presentation in their emergency departments. Only 1.7% of all non-surgical stroke discharges were from PCS rural/small-town community hospitals (15% of all US hospitals), illustrating that there is room to avoid more futile transfers. Futile transfers have financial costs for family members, such as hotels, transportation, meals, and lost wages during the patient’s care and increased negative impacts on the patient’s health. Futile transfers increase the episode of care costs to the healthcare system through added ambulance transfers and physician and facility bills, adding out-of-pocket patient costs without adding health outcomes or value.

Conclusions:
AI-SCCPs offer financial benefits to the PSC and CSC by ensuring patients are at the facility, which provides the best possible benefits for them, a triple “win” for the PCS, CSC, and patients/families. For financially strained PCSs, the retained revenue is critical. Using AI-SCCPs ensures that local hospital/emergency departments can provide timely, expert stroke care for patients and their families in situ. In cases of necessary transfer, the receiving CSC team is prepared and ready to treat these patients, saving valuable time and brain immediately.
Abstract TP122: Impact of 2021 Seconary Stroke Prevention Guidelines on Post Stroke Care Plans for Patients Transferred to Long Term Acute Care Facilities
Authors: Nguyen Viet-Huong
Published: January 2025

Background:
Classification of etiologic ischemic stroke subtype guides post-stroke care and secondary prevention. Etiologic ischemic stroke subtypes are often not clearly documented in post-stroke care plans especially when transferring from one facility to another. In 2021, AHA/ASA published updated secondary stroke prevention guidelines recommending identifying etiologic ischemic stroke subtypes when possible. The impact of this on post-stroke care is unknown.

Methods:
Charts of all patients ages 18 and up, admitted from 1/1/20 to 5/23/21 and from 1/1/22 to 5/23/23 to 3 long-term acute care (LTAC) facilities, on antiplatelet therapy, and with an ascertainable history of stroke within 90 days of admission, were retrospectively reviewed to assess for documentation of ischemic stroke subtype at discharge/transfer to an LTAC facility and to assess for appropriateness of secondary stroke prevention therapies. Care plans from those two time periods were compared to assess for any impact the 2021 guidelines may have had on discharge practices.

Results:
Subtypes were not defined for the majority of ischemic strokes. Classification by etiologic subtype was observed in 33% of cases. Classification by territory or location was more common (Fig. 1). One-quarter of patients were on dual antiplatelet therapy (DAPT) and 75% of patients were on single antiplatelet therapy (SAPT) with more patients on DAPT in the latter time period (Fig. 2A). Rationale for DAPT were not provided for the majority of patients and NIHSS and ABCD2 scored were also not commonly provided for patients on DAPT (Fig. 2B). Close to 90% of patients were treated with antihypertensives and statin therapy at discharge to LTAC; 71% of patients were treated with diabetic therapies at discharge; stroke education at discharge to LTAC was documented for 43% of patients; and LDL was documented in 56% of patients (Fig. 3).

Conclusions:
Etiologic ischemic stroke subtypes were not documented for the majority of patients transferred to LTACs. Despite recent guideline revisions, an increase in documentation of stroke subtype was not observed. Optimal secondary stroke prevention strategies were difficult to assess without this information including appropriate antiplatelet regimens. Our findings highlight the importance of the need to improve post-stroke care plans at discharge and transfer including documentation of etiologic ischemic stroke subtypes to facilitate optimal post-stroke care across all transitions.
Abstract TP123: Physician perspectives on acute evaluation and determining goals of stroke care for people living with dementia or disability: Results from the SEED mixed-methods study
Authors: Betzner William , Drozdowska Bogna , Cristall Nora , Lashewicz Bonnie , Demchuk Andrew , Smith Eric , Ganesh Aravind
Published: January 2025

Background:
Around one in three strokes are experienced by people living with disability or dementia (PLWD), yet there is currently no consensus to guide physicians in evaluating baseline status in this patient population and determining goals of care. We sought to understand how physicians currently approach this complex issue and what challenges they encounter as a critical step towards informing evidence-based best practices for PLWD.

Methods:
Through separate recruitment strategies, we invited physicians involved in stroke care to participate in semi-structured, in-depth interviews and an online survey, inquiring into perspectives on evaluation and management of PLWD. Interviews were recorded, transcribed, and analyzed applying an interpretive grounded theory approach, using constant comparison throughout the coding process to establish themes and subthemes. Results were triangulated with findings from a descriptive analysis of survey responses.

Results:
Twenty-eight physicians participated in interviews, while 134 provided survey data, representing 17 countries and 10 medical specialties. Among factors most frequently rated as extremely important in stroke care decision-making (by ≥40% of respondents) were severity of pre-existing dementia/disability and baseline quality of life. Concurrently, interviews highlighted considerable challenges in assessing these factors given time constraints in the acute setting and crudeness of popular screening measures, which fail to capture relevant nuances in patients’ baseline status. Participants further spoke to uncertainties in determining goals of care that align with patients’ best interest. Here, emphasis was placed on the inappropriateness of a mainstream conceptualization of a favorable outcome as maintaining independence, and the need to consider variability in personal and cultural values, support networks, and the broader socioeconomic context. In navigating the complexities of patient-centric care for PLWD who are often unable to voice their wishes, family input and advanced care directives were identified as key facilitators.

Conclusions:
This mixed-methods study highlights the need for creating evidence-based, tailored strategies for assessing pre-stroke status and defining favourable outcomes for PLWD. Achieving these goals relies on future research co-production with PLWD and their families, ensuring integration of patient priorities and appropriate operationalization of relevant post-stroke outcomes.
Abstract TP125: Lack of Association between Neighborhood Socioeconomic Status and Health Outcomes in Patients with Hereditary Hemorrhagic Telangiectasia
Authors: Kwan Brian , Huynh Nhu , Weinsheimer Shantel , Nelson Jeffrey , McCulloch Charles , conrad miles , Hetts Steven , Kim Helen
Published: January 2025

Introduction:
Hereditary Hemorrhagic Telangiectasia (HHT) is a rare vascular disease characterized by development of arteriovenous malformations (AVMs) throughout the body, including telangiectases on the skin, nasal and gastrointestinal mucosal surfaces and larger AVMs in the brain, lungs, and liver. AVMs can rupture causing life-threatening hemorrhage, stroke, and heart failure, thus requiring referral and management of care at specialized HHT centers. Disparities at the individual and neighborhood levels may contribute to delays in treatment and poorer health outcomes. We aimed to explore associations between neighborhood socioeconomic status (SES) and health outcomes of HHT patients.

Methods:
This is a retrospective cohort study of HHT patients enrolled in the Brain Vascular Malformation Consortium study at UC San Francisco between 2011-2024. Among 187 enrolled, 169 had valid addresses in California. The University of Wisconsin’s Neighborhood Atlas® mapping tool was used to find the State Area of Deprivation Index (ADI) of each patient’s address. The ADI uses SES data from the U.S. Census (e.g., education, income/employment, housing, and housing characteristics), but does not use race to rank the social disadvantage of geographic areas. Outcomes included age at genetic testing, HHT Severity Score (0-7 composite score factoring in AVM, anemia and stroke), and Epistaxis Severity Score (ESS) (0-10 composite score of nosebleed severity over last 3 months). Multivariable linear regression analysis test the association between ADI and health outcomes, adjusting for age and sex; statistical significance was set at p≤0.05.

Results:
The mean age of the cohort at enrollment was 41±21 years and 65% were female. Median HHT Severity Score was 2 (range: 0-6) and mean ESS was 3.2±2.2. Mean age at genetic testing was 36±20 years. The distribution of ADI was roughly uniform, ranging from 1 (least disadvantaged) to 10 (most disadvantaged). No significant association was observed between ADI and HHT Severity Score (n=150, beta=0.048, 95% CI: -0.19 to 0.114, p=0.157), ESS (n=150; beta=0.012, 95% CI: -0.100 to 0.125, p=0.829), or age at genetic testing (n=109; beta= -0.732, 95% CI: -2.07 to 0.604, p=0.279).

Conclusions:
There was no clear evidence for disparities in health outcomes of HHT patients based on their neighborhood SES within California despite a wide range of ADI values, suggesting that individual-level characteristics may play a greater role.
Abstract TP129: Both English and non-English speaking patients with large-vessel occlusion receive timely access to thrombectomy
Authors: Gallagher Aaron , Cote Andre , Tirschwell David
Published: January 2025

Introduction:
An equitable health system requires access to clinical advances across society. In stroke, mechanical thrombectomy (MT) has revolutionized the field by providing an acute therapy with unprecedented reduction in morbidity and mortality. Its benefit depends heavily on the duration between stroke onset and cerebral reperfusion. As such, patient factors associated with delays in care can influence outcomes after MT and lead to health inequities. Communication is paramount to a neurological evaluation. In a predominantly English-speaking medical system, we hypothesized that patients with a primary language other than English who presented to the hospital with large-vessel occlusion ischemic stroke (LVO) might experience delays in care resulting in longer times to MT.

Methods:
We conducted a single-center retrospective cohort study to investigate the impact of primary language on door-to-puncture time (DTP) among patients with LVO who presented to a single comprehensive stroke center between 01/2020 and 05/2024 and underwent MT. We employed non-parametric statistics to compare patient demographics and clinical outcomes and a LASSO approach to identify independent predictors of DTP.

Results:
Of the 413 patients who underwent MT, 52 (13%) were non-English-speaking (Table 1). In the overall cohort, patients were on average 71 years of age and majority male (57%). They presented to the hospital 8.1 hours after last known well with a mean NIHSS of 19. Compared with the English-speaking cohort, non-English-speaking patients presented earlier to the hospital after last known well (6.1 hours versus 8.1 hours, p = 0.110), were more likely to receive thrombolysis (33% versus 14%, p < 0.001), and had higher rates of hypertension (63% versus 44%, p < 0.008) and lower rates of congestive heart failure (12% versus 30%, p = 0.005). Neither DTP (60 minutes versus 60 minutes, p = 0.900) nor door to needle time (time to administration of thrombolytic, 43 minutes versus 47 minutes, p = 0.600) differed between non-English and English-speaking patients. Regression analysis identified a history of dyslipidemia (decreased DTP 8 min, 95% CI 2-14 min) and having received IV thrombolysis (increased DTP 13 min, 95% CI 5-21 min), but not primary language, as independent predictors of DTP.

Conclusions:
Our comprehensive stroke center promotes an equitable health system by providing a timely opportunity for MT after LVO irrespective of patient language.
Abstract TP134: Priorities and expectations of researchers, funders, patients and the public regarding equity in stroke research and funding: Results from the PERSPECT qualitative study
Authors: Ramkumar Raksha , Betzner William , Cristall Nora , Drozdowska Bogna , Fladt Joachim , Jaroenngarmsamer Tanaporn , McDonough Rosalie , Goyal Mayank , Ganesh Aravind
Published: January 2025

Background:
Considerations of equity in funding and conduct of medical research are receiving greater attention. However, perspectives of diverse stakeholder groups on this topic are poorly characterized. Our study aimed to further understand various stakeholder perspectives and associated priorities regarding perceived inequities in medical research, with a particular interest in the field of stroke.

Methods:
We employed a qualitative descriptive methodology embedded in an interpretive grounded theory framework. This approach involved in-depth, semi-structured interviews with researchers, funders, patients, and members of the public. Participants were asked to discuss their perspectives on the current state of equity in stroke and medical research funding. Collected data were analyzed using constant comparison, open-coding, and theme identification to generate a substantive theory.

Results:
We conducted 41 interviews involving 11 researchers, 10 funders, 10 patients, and 10 members of the public. Participants perceived several inequities in research participation, funding opportunities, topic prioritization, and lack of international collaborations inclusive of low- and middle-income countries (LMICs). Potential strategies to address these inequities were also identified. Through participants’ perspectives, we developed a central theory that addressing inequities in medical research and funding can promote collaborative spaces and produce greater research impact for society, regardless of demographics, socioeconomic status, and geographical residence.

Conclusion:
Participants perceived various inequities in the funding and conduct of medical research. However, based on the insights into potential solutions that we gained from their diverse perspectives, we are optimistic that addressing these inequities will help broaden the societal impact of stroke research and that these solutions will also result in more equitable outcomes and impact, inclusive of LMICs.
Abstract TP135: Streamlining Stroke Discharges: A Pathway to Seamless Transitions
Authors: Vasireddy Rani , Adams Ronald F , Campbell Margie , Lee Jessica
Published: January 2025

Background:
Patients discharged home from stroke neurology service are encountering challenges regarding follow-up appointments and had queries around medication management, necessitating considerable time investment from stroke nurse navigators and residents in approximately 10% of cases.

Objectives/Aims:
Within the next two months, the stroke neurology service aims to decrease the occurrence of post-discharge issues from 10% to 6% and reduce the time allocated to nurse navigator duties by a minimum of 20%, thus enhancing efficiency in patient follow-up and medication management processes.

Methods:
FOCUS-PDSA (Find a problem, Organize, Clarify, Understand, select intervention; Plan-Do-Study-Act) methodology was used for this project. In a one-year analysis of home discharge calls, we identified patient issues and tracked nurse navigator time per call in the month prior to initiating PDSA cycles. Over two PDSA cycles from March 1 to April 30, we implemented two interventions. First, we educated senior residents in the stroke service to sign discharge summaries instead of interns, reducing nurse navigator time spent on provider tracking. Second, we launched the "ASK me 3" campaign, encouraging patients to inquire about their care via displayed placards and signs in patient rooms and corridors.

Results/Outcomes:
In our initial PDSA cycle, only 50% of discharge summaries were signed by senior residents, and there was no significant change in nurse navigator call time. After consulting stakeholders, we revised our intervention to include the name of the senior resident on service in discharge summaries, resulting in 100% compliance and nurse navigator time has been reduced by 30% over a two-month period.

Conclusion:
Our data analysis suggests that system-based changes, such as mandating provider names on discharge summaries and implementing the "ASK me 3" campaign, may be more reliable than provider-dependent interventions. If effectively utilized, these tools could be scaled to broader settings, potentially encompassing entire department or multiple departments.
Abstract TP136: STRACK: A Continuum of Stroke Care, Improving Post-Stroke and Cardiometabolic Patient Outcomes
Authors: Cardona Pedro , Nunez Ana , Paipa Merchan Andres , QUESADA HELENA , Lara Rodriguez Blanca , Martinez Elena , Lopez Angel , Huertas Mariano , Llecha Nuria , Carmona Sonia
Published: January 2025

Background:
The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension. Collaboration between primary care centers and hospital staff was essential for the project’s success by delivering personalized care and home monitoring devices to patients through access to a digital platform. STRACK was launched with a european value-based contracting process and Roche Diag. as partner.

Methods:
The three-year project was launched in May 2021, during first year all specialties and professionals participated in the development and planning of the project and were trained in the use of the devices and own digital platform.

First STRACK patient was enrolled in May 2022. Once these post-stroke patients have been identified, they are given a personalized monitoring plan depending on the individuals’ risk factors, the personalized care and rehabilitation plans are tracked and followed. For a year post-discharge, a nursing and administrative team follows the data that the patient enters remotely or is automatically available on their mobile application.

Results:
STRACK has evolved the continuum of care by 421patient in July 2024 and ongoing, by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes, atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan, identified as key to avoiding stroke recurrence and improving control of vascular risk factors are monitored.

Preliminary results of 231 patients (May 2022-2023) with full one year follow-up comparing with historical cohort (May 2018-2019) showed: Reduction in unnecessary visits (weighted): -26,3%. Reduction in admissions for stroke recurrence or related to stroke, (heart attack, angina, peripheral embolism, etc.): Stroke, 30days: -100%; Related to stroke, (365d: -47,7%; 30d: -57,0%). Reduction in cardiovascular admissions ( 30d: -100%; 365d: -31,4%). Best treatment adherence: 81,2% (72% previously)

Conclusion:
The great value of STRACK is knowing the evolution of stroke patients post-discharge through strict self-monitoring of clinical parameters, following prior health education. STRACK has managed to achieve reduction in stroke recurrence and adverse events and readmissions for cardiovascular risk factors, reducing emergency visits for vascular events.
Abstract TP137: Reducing Opioid Prescription for Subarachnoid Hemorrhage Headache Via a Dot-Phrase
Authors: Neale Natalie , Vassar Rachel , DiBiase Rebecca
Published: January 2025

Subarachnoid hemorrhage can cause debilitating headaches, affecting 90% of these patients in the intensive care unit, and 40% at 32 month follow up. Current literature suggests that opioids are ineffective for treating subarachnoid hemmorhage pain, despite their widespread use and perceived efficacy. There is evidence that dot-phrase implementation and electronic medical record alerts can positively influence physician behavior, including with reducing opioid prescriptions in the primary care setting. We added a standardized dot-phrase to discharge summaries for our subarachnoid hemmorhage patients, prompting providers to answer whether the patient was being prescribed opioids, the rationale for this, and plan for weaning. Rates of opioid prescription inpatient were 93%, but inclusion of the dot phrase reduced opioid prescription at discharge to 14% compared to 43% in patients who did not have dot phrase included. Our results suggest that dot-phrase implementation can successfully reduce opioid prescription at discharge for this patient population.
Abstract TP139: Coordinating Stroke and Sleep Care with Field Staff and Champions: Difference-Makers in a Quality Improvement Program Addressing Sleep Apnea in Stroke Patients
Authors: Rattray Nicholas , Miech Edward , Bravata Dawn , Story Kristin , Myers Laura , KOO BRIAN , Burrone Laura , Sexson Ali , Taylor Stanley , Perkins Anthony , Daggy Joanne , Sico Jason
Published: January 2025

Background:
The Addressing Sleep Apnea Post-Stroke/TIA (ASAP) clinical trial aimed to enhance OSA management at six VA medical centers through a hybrid implementation trial, requiring coordination across hospital medicine, sleep medicine, nursing, and neurology in both inpatient and outpatient settings. This analysis evaluated the trial’s efforts to standardize early OSA screening in stroke/TIA patients.

Methods:
This mixed-methods evaluation used configurational comparative methods (CCMs) to identify key contextual factors for successful implementation, examining the joint effects of multiple factors. The stepped-wedge trial ran from May 2019 to January 2024 across three implementation waves. The primary outcome was the Group Organization (GO) score, which measured team cohesion in managing sleep apnea among cerebrovascular patients. Data sources included observational data, qualitative interviews, and administrative data across three periods (A, B, C), calibrated into dichotomous or multi-value categories for analysis.

Results:
Four key difference-makers distinguished more successful sites (GO score ≥6) from others: routines for ordering inpatient OSA tests, patient care coordination during hospitalization, involvement of field staff, and strong local champions. The ability to order and complete sleep studies was crucial for timely OSA diagnosis. Field staff (e.g., respiratory technicians, polysomnographic technologists, research) played a critical role in coordinating care during inpatient stays and post-discharge. Key pathways to success included active field staff engagement and strong champion support, particularly in the final phase. Less successful sites faced barriers like geographic separation and staff shortages. The figure describes the values for each of these factors at the 4 more successful versus 2 less successful sites.

Conclusions:
The study highlights the importance of flexibility in integrating new practices, particularly in stroke care requiring multi-specialty coordination. Findings provide a roadmap for healthcare systems implementing similar interventions, emphasizing leadership, coordinated care, and robust tracking for program success.
Abstract TP142: Trends in Stroke-Related Mortality Among Coronary Atherosclerotic Disease Patients Aged 45 and Older in the United States and Texas: An Analysis Using the CDC WONDER Database
Authors: Naz Sidra , Lohana Sameer , Hazique Mohammad , Hotwani Priya , Naz Hira
Published: January 2025

Introduction:
Coronary atherosclerotic disease (CAD) carries the highest risk of recurrent stroke, up to 15% annually, and individuals with coronary heart disease are twice as likely to have a stroke. This study aims to analyze annual mortality trends and sociodemographic factors related to stroke in CAD patients in the U.S. and Texas from 1999 to 2020, to inform public health policies.

Methods:
Using the CDC's WONDER database from 1999 to 2020, focusing on stroke and CAD-related mortality(ICD-10 code I64.0 “Stroke”&Code I25.1 “Atherosclerotic heart disease ”) in adults aged ≥45 years, annual percent changes(APCs) in age-adjusted mortality rates (AAMRs) with 95% confidence intervals across various demographic (sex, race/ethnicity, age) subgroups were calculated.

Results:
The AAMR for stroke-related mortality in CAD cases reduced in the US from an adjusted rate(AR) 174.5 in 1999 to 105.2 in 2009(APC: 5.48%; 95% CI: -6.09% to -5.24%) after which it reduced further to 69.4 in 2018(APC: -7.87%; 95% CI: -8.77% to -6.53%) then it increased to 75.9 in 2020(APC: 4.38%; 95% CI: 2.63% to 5.88%). In Texas, AAMR for stroke-associated CAD-related mortality overall decreased from AR 189.7 in 1999 to 73.5 in 2020(APC: -4.96%; 95% CI: -5.27% to -4.66%). Males had higher consistently higher AAMRs than females (83 vs. 69.5). The AAMR in the US men decreased from 183.7 in 1999 to 72.9 in 2018(APC: -7.23%; 95% CI: -8.22% to -5.92%), then it increased to 83 in 2020(APC: 6.40%; 95% CI: 4.31% to 8.19%). The AAMR in the US women decreased from 166.3 in 1999 to 65.7 in 2018(APC: -7.89%; 95% CI: -8.79% to -6.63%) after which it increased to 69.5 in 2020(APC: 2.38%; 95% CI: 0.49% to 4.06 %). The non-Hispanic (NH) Black or African American (AA) has the greatest AAMR (122), followed by the NH American Indian or Alaska Native with an AAMR (76.8) and the NH White population with an AAMR (72.9). The low-risk populations were the Hispanic or Latino (58.8) and the NH Asian or Pacific Islander (54.2). AAMR also varied by region (overall AAMR: Midwest: 82.1; South:82; Northeast:67.1; West:66.4)&non-metropolitan areas had higher AAMR (non-core areas:98.5; micropolitan areas:94) than metropolitan areas (large fringe areas:69.3; large central metropolitan areas:66.7).

Conclusions:
The stroke-related mortality in CAD cases has overall risen in the US compared to Texas over the past two decades, specifically men and (NH) Black or AA, (NH) American Indian or Alaska Native and (NH) White are at high risk.
Abstract TP149: Development and Implementation of an Algorithm for Early Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Acute Stroke Patients
Authors: Rondon Alison , Oldach Sara , Sher Karen , Teachman Marissa , Babruk Anna , Alberts Mark
Published: January 2025

Background:
Dysphagia is a common complication of stroke and often leads to the need for modified diets and alternate feeding routes. Length of stay (LOS) for stroke patients requiring percutaneous endoscopic gastrostomy (PEG) tubes is often longer than those who can eat by mouth. The decision to place a PEG is multifactorial and multidisciplinary, involving speech-language pathologist (SLP), dietary, and neurology input, as well as goals of care. Despite this complex decision-making process, there are few existing algorithms to guide the need and timing for PEG placement.

Hypothesis:
Use of a PEG algorithm will result in timelier PEG placement and shorter LOS for acute stroke patients requiring artificial nutrition.

Methods:
A multidisciplinary team, including physicians, nurses, registered dieticians, and SLPs designed an evidenced based algorithm to guide PEG placement. Based on assessment and individual patient factors, possible algorithm pathways included dysphagia treatment and/or calorie count by nursing and dieticians to guide decision-making for PEG placement.

A retrospective study was conducted in the inpatient setting of a comprehensive stroke center. Data included 68 acute ischemic and hemorrhagic stroke patients admitted to the Neurology and Neurosurgery services from 1/1/2023-2/29/24. Only those patients who were identified as being at risk for significant oropharyngeal dysphagia, aspiration pneumonia, and/or malnutrition were included in the study. Data collected included age, diet recommendation, and initial National Institutes of Health Stroke Scale Score with a focus on length of time from PEG recommendation to PEG placement and LOS. Statistical analysis was completed via t-test.

Results:
Comparing algorithm (n=30) and non-algorithm (n=38) groups, there was an average decrease of 3.86 days from PEG recommendation to placement in the algorithm group. Although this was not statistically significant (p=0.211), this resulted in decreased LOS from 24.2 to 20.0 days and hospital savings of ~ $7,720 per patient.

Conclusions:
Implementation of a multidisciplinary PEG algorithm resulted in reduced time from PEG recommendation to placement and shorter LOS. This novel process helped to guide decision-making for timelier PEG placement. Ongoing studies will be powered to assess overall impact on LOS, costs, outcomes, and complications.
Abstract TP150: Association of Stroke Severity with Post-Stroke Depression and Household Size
Authors: Cahuiche Ana , Petway Ana , Enochs Carolyn , Couture Lucy , Delevati Colpo Gabriela , McCullough Louise
Published: January 2025

Introduction:
Stroke is a significant global health challenge, impacting physical and mental well-being, with many neuropsychiatric symptoms contributing to worse functional outcomes. Post-stroke depression (PSD) is a common neuropsychiatric consequence of stroke, affecting approximately one third of stroke survivors. PSD is associated with worse functional outcomes, higher mortality rates, and reduced quality of life.

Hypothesis:
We hypothesize that patients with higher stroke severity scores on admission will have higher levels of immediate depressive symptoms and have a smaller household population.

Methods:
This study examines the predictive power of immediate post-stroke depressive symptoms and functional outcomes at 3- and 12- months post hospitalization. 130 patients with Ischemic stroke were enrolled and completed a standard battery of questionnaires during their hospitalization. Post-stroke depression was measured via PHQ-9 scores, with scores above 5 denoting moderate to severe depressive symptoms. Acute stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS), with increasing scores indicating more severe strokes.

Results:
Analyzing stroke severity and PSD development among patients with ischemic stroke, our statistical analyses revealed that larger household size significantly protects against PSD. For acute stroke injury, we found that patients living with fewer people at baseline are more likely to have a higher NIHSS score (p<0.05). Furthermore, after controlling for injury severity, increased household size at baseline was associated with significantly lower occurrence of PSD immediately after, and 3- months after stroke (p<0.05). When controlling for household size, female stroke patients are more likely to suffer from depressive symptoms at 3- months, in comparison to their male counterparts (p<0.005).

Conclusion:
PSD emerged as a statistically significant factor for impaired functional outcomes, highlighting the importance of early intervention and management of depression in stroke care. These findings underscore the necessity of integrating early identification and treatment of depressive symptoms in stroke patients, particularly those with smaller household size and female patients. Future research aimed at exploring mechanisms behind the protective effects of larger households and sex differences in PSD is necessary to inform targeted therapeutic strategies.
Abstract TP153: Review of Hospital Outcomes for Aneurysm Securement in SAH at a Midwest Comprehensive Stroke Center
Authors: KASHYAP BHAVANI , Holt Elizabeth , Jones Lauryn , Conway Luke , Smalley Isaac , Wiegman Ella , Haveman Abbey , Hoversten Knut
Published: January 2025

Background:
According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia. Efficient aneurysm securement in the hospital setting is critical to survival; however, analysis of aneurysm timing and care in the pre-hospital setting is difficult. In this quality improvement study, we reviewed hospital data to improve our outcomes for patients with aneurysmal SAH.

Methods:
We conducted a retrospective analysis of hospital outcomes and stroke metrics for 72 patients with last known well times who underwent securement for aneurysmal SAH at a comprehensive stroke hospital in upper Midwest from Jan 2016 to Jul 2024. Data were compiled from multiple resources including Get-With-The-Guidelines®, chart abstraction, and internal healthcare databases. We compared 0-24 hours (n=49) and >24 hours (n=23) ‘Onset to Treatment’ groups using appropriate statistical tests and significance was determined using a two-sided alpha of 0.05.

Results:
Demographics (age, sex), cerebrovascular risk factors (hypertension) were similar between both groups. No differences were noted in the size or location of aneurysm. Interestingly, the symptom presentation (altered level of consciousness [48% (0-24), 26% (>24)]) and severity were higher in 0-24 group, including the NIH stroke scale (p-0.04), Hunt and Hess score (p-0.06), and Glascow Coma Scale (p-0.05). Modified Rankin scale (mRS) least favorable outcomes (5 and 6) were higher in 0-24 group (33% [0-24],17.3% [>24]) and more external ventral drains were placed (70% [0-24], 57% [>24]), though no change in overall hospital outcomes was noted, including mRS at discharge and discharge disposition between the groups. No differences were noted in ‘Door to Treatment’ times between the groups (12 [0-24] vs 14 hours [>24], p-0.16).

Conclusion:
At our hospital, there were no significant differences in overall outcomes for patients treated before or after 24 hours of symptom onset for aneurysmal SAH. Additionally, no impact of ‘onset to door’ times on hospital metrics for securement was noted. Lastly, an interesting trend in patients who arrived within 24 hours of symptom onset had a higher severity of symptoms, greater complications, and an increase in least favorable outcomes, suggesting the importance of early recognition and education regarding SAH presentations.
Abstract TP154: Optimizing Stroke Care: A Pilot Study on Secured Clinic Slots for Timely Follow-Up
Authors: Nelson Favour , Pulakanti Varun
Published: January 2025

Introduction:
The initial 1-3 months following a Transient Ischemic Attack (TIA) or acute stroke are critical for patient management and recovery. Timely follow-up care is recommended to reduce the risk of recurrent stroke and address ongoing health issues. Prolonged hospital stays can hinder prompt outpatient follow-up. We present a pilot model of secured slots for urgent stroke referrals and follow-up for TIA and acute stroke patients.

Methods:
A three-year pilot study was conducted within the Geisinger Medical Center Vascular Neurology and Stroke Clinic from October 2021 to June 2024. Dedicated 3:00 PM time slots were established for urgent referrals and follow-ups of patients with TIA and acute stroke from the Emergency Department(ED). Three neurology physicians shared these slots. The study evaluated slot utilization, including time from discharge to clinic visit, 90-day unplanned stroke readmission rates, and the percentage of inappropriate slot use. An integrated assessment was performed to determine the program's impact on clinic workflow and patient outcomes.

Result:
An initial review of the first 200 patients revealed the following utilization of secured slots: 21.5% for urgent referrals, 22% for ED follow-ups, 20.5% at provider discretion, 15% allocated by triage team decision, and 18.5% for routine follow-ups. No-shows and scheduling errors accounted for 2.5% of the slots. For urgent referrals and ED follow-ups, there were no unplanned hospital admissions within 90 days. The time to clinic visits after ED discharge ranged from 1 to 21 days (mean 6.9 days), compared to the national average of 2-8 weeks. Many patients underwent partial stroke workups in the ED or hospital. Outpatient testing such as TTE, and ambulatory rhythm monitoring were coordinated to reduce hospital stays. Limitations included challenges in scheduling appointments within 24-72 hours due to provider availability, weekends, and patient scheduling conflicts.

Conclusion:
Secured stroke clinic slots provide a timely opportunity for high-risk patients to receive immediate follow-up care after ED visits for stroke or TIA. This model significantly reduces hospital costs and improves patient readmission rates, and burden of prolonged hospital stays, without compromising care. Future studies are encouraged to focus on streamlining referrals, reducing scheduling errors, and integrating this model with other stroke-related services, such as rehabilitation to further enhance overall patient care.
Abstract TP158: Collaboration Between Neurology and Endocrine Improves Uncontrolled Diabetes for Patients with Acute Ischemic Stroke
Authors: Chambers Kathleen , Man Shumei
Published: January 2025

Background:
Research suggests that the absolute number of strokes among people with diabetes is increasing as the population with diabetes grows. Stroke patients with poorly controlled diabetes are more likely to experience poor functional recovery, longer recovery times, recurrent stroke, and higher risk of death. In response to a finding from the 2021 Joint Commission survey for not addressing an HbA1c=9.3, we launched a quality improvement project to enhance diabetic management among patients admitted for ischemic stroke.

Methods:
This interdisciplinary collaboration involved endocrinology, hospital medicine, and neurology. For patients admitted to our Thrombectomy-Capable Stroke Center for ischemic stroke with an HbA1c ≥ 9.0% or blood glucose glucoses≥250mg/dl, a mandatory inpatient endocrine consult would be provided, in addition to diabetic educator consult. The patient’s HbA1c levels were followed every 3 months for a year.

Results:
A total of 66 patients were admitted in 2022 (n=32) and 2023 (n= 34) for ischemic stroke with HbA1c ≥ 9.0%. The median HbA1C for 2022 cohort dropped from 11.2% (range 9.0% – 16.6%) to 8.5% (range 5.0% - 14.1%) in a year (p<0.05); and 10.3% (range 9.0% - 14.6%) to 7.75% (range 6.0% - 11.7%) in a year (p<0.05). 2024 data showed similar improvement with drop of HbA1c from 10.55% to 9.75% at 3 months and 9.45% at 6 months.

Conclusion:
Inpatient endocrinology involvement for high-risk stroke patients with previously uncontrolled diabetes improves diabetic control over time. Endocrinologists can offer personalized treatment plans considering various factors such as comorbid conditions, patient lifestyle, and specific diabetes complications. This single center intervention is congruent with published data showing that patients under specialist care often experience HbA1c reductions of 0.5% to 1.0% or more compared to those managed by general practitioners. In high risk and high complexity cases, this improvement may potentially lead to reduced risk of stroke recurrence and complications. We postulate that this improvement is attributed to the endocrinologist’s expertise in complex diabetes management, advanced treatment options, personalized care approaches, and resources in post-discharge management. If confirmed in a multicenter clinical study, it can become a generalizable approach to improve the quality of care and outcomes of high-risk stroke patients.
Abstract TP162: Artificial Intelligence-Based Approach for Localization of Intracranial Aneurysms on Head MRI Images
Authors: Ikedo Taichi , Ren Nice , Nishimura Kunihiro , Otsuka Ryotaro , Iihara Koji , Kataoka Hiroharu
Published: January 2025

Background:
Detection of intracranial aneurysms (IAs) is a time consuming and error prone process. Therefore, solutions that can localize IAs with a high sensitivity are required. Several artificial intelligence (AI)-based automated diagnoses on medical images have recently been reported. We aimed to develop an automated diagnosis system for the location and maximum diameter of IAs on MRI images in the present study.

Methods:
In 1310 patients with or without IAs, 937 MRIs were used for training data and 373 cases for test data. The definition of the correct diagnosis of the location was that the center of the aneurysm diagnosed by the AI system is within the area of the IA of ground truth. The nnU-Net was used for the deep learning. Developed AI system was verified with 5-fold cross validation with test data. The maximum diameter was automatically calculated from extracted domes of IAs.

Results:
Of the 937 patients used for the model development, 778 (83%) had IAs including 146 patients (19%) with multiple aneurysms and 159 (17%) had no IA. In total 1213 IAs, 78% were small aneurysms of 2 to 5 mm. Of the 373 cases for the validation, 17 (4.5%) had IAs, which is close to the real-world setting. Internal validation of the developed diagnosis model for IA locations showed high efficiency of AUC = 0.92, sensitivity = 15/17 (88%), and false negative rate = 0.44 aneurysms/person. The diameter diagnosis model for the maximum diameter also achieved high accuracy within 1.2 mm of mean absolute error.

Conclusion:
We successfully developed a powerful diagnosis model for IAs with AI technique. The present model potentially reduces human effort required for the IA diagnosis.
Abstract TP163: Single- and Multi-Phase Computed Tomography Angiography Are Associated with Digital Subtraction Angiography and American Society of Interventional and Therapeutic Neuroradiology Collateral Score of Three or Greater
Authors: Srinivas Tara , Lakhani Dhairya , Balar Aneri , Xu Risheng , Salim Hamza , Yedavalli Vivek
Published: January 2025

Introduction:
Imaging features are increasingly relevant for predicting response to endovascular treatment in acute ischemic stroke (AIS) patients. Collateral status is a well-documented marker of reperfusion and mortality in patients with large vessel occlusion (LVO) anterior circulation strokes, which account for approximately one-third of AIS. There is ongoing investigation into optimal collateral status determination, with single and multiphase computed tomography angiography (mCTA) and CT perfusion parameters under consideration. To assess the utility of these parameters, we evaluated their association with the American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score standard on digital subtraction angiography (DSA).

Methods:
We retrospectively evaluated AIS patients treated at our institution between January 2017 and January 2023. Inclusion criteria were: (i) CTA-confirmed anterior circulation LVO; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was attempted with documented DSA collateral score. Modified Treatment in Cerebral Ischemia (mTICI) score was used to determine reperfusion status, with mTICI > 2b considered successful. Univariate and multivariate logistic regression analyses were conducted to determine associations of demographic/clinical factors and collateral status with ASITN and reperfusion status.

Results:
A total of 311 patients (mean age 67.35 ± 16.37, 57.4% female) met inclusion criteria. On univariate analysis, PM2 occlusion site (p=9.78E-7), Alberta Stroke Programme Early CT Score (p=0.006), mCTA (p=1.82E-10), cortical vein opacification score (p=4.18E-7), and clot burden score (CBS, p=3.01E-13) were associated with ASITN score of three or greater, signifying complete collateral flow. On multivariate regression adjusted for race, occlusion site, radiologic features, and admission NIH stroke score, PM2 occlusion site (aOR 1.19, p=0.049), mCTA (aOR 3.59, p=6.03E-5), and CBS (aOR 1.37, p=0.03) were associated with ASITN ≥ 3 (Table 1). No radiologic features were associated with successful reperfusion (Table 2).

Conclusion:
Multiphase CTA and clot burden score show a stronger association with favorable DSA collateral scores than do CT perfusion parameters, including cerebral blood volume and hypoperfusion intensity ratio. Further studies are needed to evaluate these measures in outcome prediction to aid clinical decision-making for AIS patients with anterior circulation LVOs.
Abstract TP168: Automated CT perfusion Parameters as Predictors of Hemorrhagic Transformation After Mechanical Thrombectomy in Large Vessel Ischemic Stroke
Authors: Montalvan Victor , Tan Yuanyuan , Marginean Horia , Neves Gabriel , Ota Riichi , Hernandez Roberto , Barnes Robert , Brister Rorie , Chintakayala Laxmi , Hendley Katie , Zurasky John , Albers Greg
Published: January 2025

Introduction:
Hemorrhagic transformation is a common complication of mechanical thrombectomy (MT), often as a result of reperfusion injury. We investigated the correlation between automated CT perfusion (CTP) parameters and Hemorrhagic transformation after MT in acute ischemic stroke.

Method:
We conducted a retrospective cohort analysis of patients consecutively admitted to the Providence Health System between January 2018 and February 2022 with acute ischemic stroke who underwent MT and had a CTP on admission. We also addressed each CTP parameter’s predictive power through bivariate logistic regression and ROC/AUC analysis. We compared the median and IQR ranges of volumes of automated CTP parameters between patients with and without ICH. Any degree of hemorrhagic transformation in the ECASS II classification system was considered ICH. Symptomatic intracranial hemorrhage (sICH) was defined by The Heidelberg Bleeding Classification. (4 point increase in NIHSS, or 2 in one NIHSS subcategory, major medical/surgical intervention involved)

Results:
We included 513 patients with a ischemic stroke who had an MT. Median age was 75(63, 85) years old. Higher blood sugar (p=0.003) and chronic kidney disease (p=0.001) were significantly associated with sICH Table1. Cerebral blood flow( CBF)<30%, cerebral blood volume (CBV)<38%, CBV<42%, mismatch ratio, and CBV index were associated to sICH as shown in Table 2. ROC analysis for CBV index showed an AUC of 0.64 in the bivariate analysis. Other CTP parameter logistic regression and an ROC/AUC analysis are shown in Table 3.

Conclusion:
Higher CBF<30%, CBV<38%, and CBV<42% volumes were associated with an increased frequency of ICH and sICH. Higher mismatch ratios correlated with a lower frequency of ICH and sICH. Lower hypoperfusion index; and, elevated Tmax volumes >10s and >8s, were associated to a higher frequency of ICH. However, these parameters were insufficiently powered to show a significant association with sICH. CBV index outperformed the other CTP parameters in the ROC analysis. Larger studies are needed to clarify these associations.