bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 56: Acute Stroke Reperfusion Treatment Rates at NIH StrokeNET Hospitals
Authors: Adeoye Opeolu , Kleindorfer Dawn
Published: July 2021

Background:
In 2013, the NIH Stroke Trials Network (StrokeNET) was established to maximize efficiencies in stroke clinical trials. Successful recruitment in future trials was required for participating sites. A high volume of cases treated is a surrogate for the potential to recruit. Among Medicare-eligible acute ischemic stroke (AIS) cases, we estimated the IV rt-PA and endovascular embolectomy treatment rates at StrokeNET Regional Coordinating Centers and their partner hospitals compared with non-StrokeNET hospitals in the United States (US).

Methods:
We used demographics and IV rt-PA and embolectomy rates in the 2013 Medicare Provider and Analysis Review (MEDPAR) dataset. ICD-9 codes 433.xx, 434.xx and 436 identified AIS cases. ICD-9 code 99.10 defined rt-PA treatment and ICD-9 code 39.74 defined embolectomy. Demographics and treatment rates at StrokeNET and non-StrokeNET sites were compared using t-test for proportions and Chi-square test for categorical variables as appropriate.

Results:
Of 386,157 AIS primary diagnosis discharges, 5.1% received IV rt-PA and 0.8% had embolectomy (Table). By June 6, 2014, StrokeNET comprised 247 acute care hospitals that discharged 48,946 (13%) out of 386,157 AIS cases. rt-PA (7.4% vs 4.8%) and embolectomy (1.9% vs 0.6%) treatment rates were higher at StrokeNET hospitals. In 2013, 36% of StrokeNET hospitals treated more than 20 AIS cases with rt-PA or embolectomy compared with 6% of non-StrokeNET hospitals (P<0.0001).Conclusions

StrokeNET hospitals treat more AIS cases with acute reperfusion therapies. Thus, StrokeNET could successfully recruit in acute reperfusion clinical trials depending on study size, capture of eligible patients and the number of competing trials. We likely underestimated treatment rates due to not accounting for drip-and-ship and non-Medicare cases. To further enhance enrollments in large acute reperfusion phase 3 trials, partnership with high volume non-StrokeNET hospitals may be warranted.
Abstract 57: The Effect Of Routine Oxygen Supplementation on Long Term Functional Outcomes and Quality of Life After Stroke: 6 and 12 Month Outcomes The Stroke Oxygen Study
Authors:   The Stroke Oxygen Study Collaborators, Nevatte Tracy , Sim Julius , Gray Richard , Ives Natalie , Bishop Jonathan , Pountain Sarah , Crome Peter , Roffe Christine
Published: July 2021

Introduction:
Routine oxygen supplementation (ROS) is commonly prescribed to prevent stroke-related hypoxia and secondary brain damage. However, early results of The Stroke Oxygen Study (SO2S) show that routine oxygen supplementation does not affect mortality and disability at 3 months.

Objectives:
to establish whether routine oxygen supplementation early after acute stroke improves long-term functional outcome and quality of life after stroke.

Methods:
SO2S is a large multicentre randomized controlled trial. Patients with acute stroke were eligible for inclusion within 24h of hospital admission if they had no definite indications for or contraindications to oxygen treatment. Participants were randomised 1:1:1 to continuous oxygen, oxygen at night (between 21:00-06:00) only, or to control (room air) for 72 h. Oxygen was given at a rate of 3L/min if the baseline oxygen saturation was ≤93% and at 2L/min if it was >93%. Follow-up was at 3, 6 and 12 months by postal questionnaire with telephone follow-up for non-responders.

Results:
8003 participants were recruited from 136 hospitals in the UK from April 2008 to June 2013. The median age was 74 (range 19-100) y, 4398 (54.9%) were male, and the baseline NIHSS score was 5 (range 0-34). We will present long-term outcomes including mortality, disability (mRS), the ability to perform activities of daily living (BI, NEADL) and quality of life (EQ5D). Comparisons will be between ROS and control, and between nocturnal versus continuous ROS. A longitudinal repeated measures analysis across all three time points (3, 6 and 12 months) will also be presented.

Conclusion:
The results of this large study will give a definitive answer to the question whether routine oxygen supplementation affects long-term outcome. They will also show whether there is a difference in the level of effectiveness when oxygen is given continuously rather than at night only, when patients are most likely to become hypoxic.
Abstract 66: Is Hospital Discharge Day of the Week Associated with Measures of Care Continuity for Stroke Patients?
Authors: Prvu Bettger Janet , Lender Stacy , Nutter Diane ,   on behalf of the Ohio Coverdell Stroke Program
Published: July 2021

Background:
Facilitating care continuity from hospital to home has been shown for other disease states to reduce adverse health events. In this study we examined whether weekend discharges were less likely to have a follow-up appointment scheduled with either primary or specialty care for acute stroke patients discharged home.

Methods:
We examined data from 44 hospitals participating in the Ohio Coverdell Stroke program to determine the proportion of adult stroke patients discharged home who had a follow-up appointment scheduled with primary care or with specialty care (neurology, neurosurgery, or neurology provider) and whether this varied by patients’ hospital discharge day of the week (weekday vs. weekend). Facilitators and barriers to scheduling appointments prior to discharge were reported by stroke team members at a meeting of participating hospitals.

Results:
Among 44 hospitals, there were 4,635 patients discharged home from April-December 2013. Prior to discharge, hospital staff scheduled follow-up appointments for post-discharge care with a primary care provider for 15.2% of patients and with a specialty care provider for 27.2% of patients. A higher proportion of patients with a weekday discharge compared with weekend discharge had a follow-up appointment with primary care (16.4% vs. 8.5%, p<0.001) and specialty care (29.6% vs. 17.5%, p<0.001). Reported barriers to facilitating care continuity for weekend patient discharges included lack of availability of dedicated weekend hospital personnel to plan appointments with the patient and family, and limited or no access to online or electronic appointment scheduling or primary or specialty care office staff to schedule appointments.

Conclusions:
Although a significant number of patients were discharged home without a primary or specialty care appointment, patients discharged on the weekend were at a disadvantage for having a follow-up appointment scheduled prior to hospital discharge. Discharge planning earlier in the hospital stay and creative approaches to improving appointment scheduling with community-based providers could be explored as options for promoting improved care continuity for weekend discharges.
Abstract 82: Patient and Hospital Characteristics of Pregnancy-Related Stroke from the Get With The Guidelines Stroke Registry
Authors: Leffert Lisa , Clancy Caitlin , Bateman Brian , Cox Margueritte , Schulte Phillip , Smith Eric , Fonarow Gregg , Kuklina Elena , Schwamm Lee , George Mary G
Published: July 2021

Background:
Stroke accounts for 14% of maternal deaths. Our knowledge of the risk factors and etiologies of pregnancy-related stroke (PRS) is limited, as most data are derived from small, single center series or large, administrative datasets lacking clinical detail. We sought to describe the patient and hospital characteristics of PRS by analyzing the Get with the Guidelines (GWTG) Stroke Registry.

Methods:
All female patients aged 18-44 entered into GWTG from 2008-2013 with PRS were ascertained by medical history of pregnancy (i.e. pregnant or <6 weeks postpartum) plus a principal diagnosis ICD-9 code (430, 431) (58%), PRS ICD-9 code (671.5x, 673.04, 674.0x) as the principal diagnosis alone (18%), or with a medical history of pregnancy (24%). Proportions for categorical and medians for continuous variables are reported.

Results:
We identified 46043 patients with stroke from 1554 sites, of whom 668 (1.5%) had PRS. Ischemic stroke (IS) occurred in 338 (51%), intracerebral hemorrhage (ICH) in 178 (27%) and subarachnoid hemorrhage (SAH) in 152 (23%). Many patient and hospital characteristics differed significantly by stroke subtype (Table). Hypertension, smoking and pre-stroke therapy with antithrombotics or antihypertensives were common; 7.4% of IS were recurrent. About 86% of all strokes did not occur in a healthcare setting and only 27% of patients arrived by EMS. Median initial blood pressure (BP) was higher in HS (ICH and SAH) than in IS, and half of all patients had initial BP below the threshold for pre-eclampsia (140/90 mmHg). HS patients were more often treated at larger, academic hospitals.

Conclusions:
PRS constituted 1.5% of all strokes aged 18-44 in a large contemporary stroke registry and 50% were HS. Most PRS occurred out of hospital, and half of all cases presented with normal BP levels. Further research is needed to better define PRS etiology.
Abstract NS1: Sustained Reliability in Dysphagia Screening by Registered Nurses
Authors: Daniels Stephanie K , Pathak Shweta , Morgan Robert O , Anderson Jane A
Published: July 2021

Background and Purpose:
Registered nurses (RNs) are critical to the rapid completion of dysphagia screening as individuals presenting with stroke symptoms must have swallowing screened prior to oral intake including aspiration. With many swallowing screening tools, RNs are required to make judgments routinely performed by speech-language pathologists (SLP). We hypothesized that RNs could obtain and sustain high inter-rater reliability in completing dysphagia screening.

Methods:
RNs routinely working with stroke admissions at the Michael E. DeBakey VA Medical Center were recruited (N=15). They underwent a 20 minute didactic training concerning stroke and dysphagia which included observation of a video recording showing execution and interpretation of the screening items (lethargy, dysarthria, wet voice, abnormal volitional cough, and response to water swallow: cough, throat clear, wet voice). Following this, the RN was required to demonstrate correct administration and interpretation of the screening items using study staff and video clips of dysphagia screenings prior to screening patients. To establish RN inter-rater reliability, a randomly selected RN from the cohort of trained nurses and an SLP made simultaneous independent judgments of the same observations obtained from the screening of a stroke participant.

Results:
Between October 2012 and June 2014, 199 dysphagia screenings were completed. Overall, substantial reliability was identified between the RNs and the SLPs (k[SE] = .79[.02]) and was comparable to SLP inter-rater reliability (.83[.03]). Completion of <20 screenings (n = 10) resulted in substantial reliability (.74[.03]), while completion of >20 screenings (n = 5) yielded almost perfect reliability (.83[.02]). RNs with at least 20 screenings showed consistent improvement in reliability over time with an average increase of 19% (range 6.2% to 40.2%) when comparing earlier screenings to later screenings.

Conclusions:
RNs are reliable in obtaining and sustaining reliability in accurately completing dysphagia screening. Practice improves performance with high levels of sustained reliability achieved with completion of 20 screenings.
Abstract NS10: Reducing Readmission Rates Bedside Nursing Led Discharge Rounds
Authors: Blue Jennifer S , Clifton Diane L , Meinel Patricia A , Muller Holly
Published: July 2021

BACKGROUND:
A national benchmark does not exist identifying a rate for readmission of patients with ICD-9 codes for Stroke. The facility set its own benchmark goal of 13%. Analysis of the data for fiscal year 2013 found that 5 of 12 months of the fiscal year exceeded the benchmark goal ranging from 14.9% to 18.6%. Going into fiscal year 2014 It was realized that CMS would not reimbursement for readmissions within the first 30 days after discharge it was apparent that a process to reduce the readmission rate for stroke patients would be essential.

PURPOSE:
Implementation of a discharge rounding will reduce readmission rates to the benchmark goal of 13% for patients admitted with a stroke.

METHOD:
A discharge review process was started in September 2013 prior to the start of fiscal year 2014. The discharge review process was conducted by a phone conference including all patient care units. The participants from each unit included the director and charge nurse reviewing the readiness for discharge of patients on the unit. The information included in the process was a list of patients anticipated to be discharged and any potential barriers. This process would be evaluated at the end of each fiscal quarter with revisions made if goal was not met.

CONCLUSION/RESULTS
The initial discharge process conference calling resulted in a reduction of readmission rate to an average of 8.9% for the stroke patient. It was noted that the process was generic and needed to be tailored for specific patient populations if it was to be sustainable. The process was revised and decentralized to the unit level with the addition of case manager. In April 2014 the data was reviewed and found a readmission percentage rate of 7.4% for the quarter. The success of the project was reducing the rate well below the benchmark that had been set. To continue the trend rounds were brought to the nursing care area to include the bedside nurse. A discharge rounding tool was to be complete prior to discharge rounds.

Data for the month of May 2014 shows a reduction in the rate to 5.3%. The discharge rounding has reduced the readmission rate for the Stroke patient and has exceeded the benchmark goal for two fiscal quarters suggesting the process is sustainable.
Abstract NS15: Adult Daughters’ Problems in Caring for Parents
Authors: Pierce Linda L , Sommer Lisa , Gies Cheryl , Steiner Victoria
Published: July 2021

Background:
Women provide most of the unpaid care to family members. Transitioning from the role of adult daughter to caregiver can be very stressful and unsettling.

Purpose:
Guided by Friedemann’s
framework of systemic organization
,
the purpose of
this descriptive secondary data analysis was to examine problems reported by adult daughters in the first year of caring for a parent with a stroke. Problems in caring can lead to poor health/
incongruence
.

Method:
An IRB approved randomized controlled trial conducted with 73 adult caregivers in Ohio and Michigan examined the experience of caring for someone with stroke. Open-ended questions were included in bimonthly telephone interviews asking caregivers to recall their problems in caring over the past two weeks. For this secondary data analysis, problems reported by only the adult daughters (n=13) were analyzed during two time periods (0-6 and 7-12 months) using Colaizzi’s rigorous method of content analysis.

Results:
The first theme of witnessing a parent’s condition centered on the adult daughter recognizing changes in their parents’ health condition and behavior (Friedemann’s process dimension of
system maintenance
). This theme was consistently apparent throughout 12-months of caring. The second theme, balancing the challenges of the caregiver role
,
dealt with the struggles and adaption necessary for her new lifestyle of a caregiver (
system maintenance and individuation
).This theme was noticeable throughout the entire year, but more evident in the second 6-months. The final theme, feeling physically, emotionally, and mentally drained, involved problems associated with the overall exhaustion experienced by adult daughters (
system maintenance
). This theme was seen throughout the 1-year period, but more visible in the first 6-months of caring.

Conclusions:
The findings provide specific, theory-based themes of the adult daughters’ problems during that year of caring that could lead to
incongruence
in their lives. The information gleaned may offer nurses and other healthcare providers a clearer picture of the problems these daughters experience, leading to more targeted interventions, increased support, and ultimately improved overall health/
congruence
for daughters.
Abstract NS25: Alteplase Administration in the Very Elder
Authors: Klassman Lynn , Siegele Peggy , Behrens Dee , Boerschinger Joy , De Re Karen , Fitzpatrick Joyce , Jenkins-West Dinene , Jennrich Mary Kay , Masor Minna , Murczek Kate , Peterson Kristin , Pouliot JoAnne , Steinkoenig Victoria
Published: July 2021

Background /Purpose:
The highest rate of first time strokes occurs in those 80 years and older. Despite the higher stroke rates, increased incidence of atrial fibrillation and often increased severity of stroke in the very elderly, initial clinical trials related to intravenous alteplase did not recruit patients over 80 years of age. Newer evidence supporting use of Alteplase in the very elder recommends that age alone should not be a contraindication for administering alteplase and urges that the risks and benefits be carefully weighed. Additional evidence concludes that although elderly patients have a higher mortality rate and poorer functional outcomes, this finding is consistent with the natural course of aging and treatment benefit may be realized. The purpose of this multihospital system retrospective review is to examine data in patients who received alteplase with the hypothesis that elders greater than 80 years benefited just as much from treatment when compared to those less than 80.

Methods:
Retrospective data collected at a large Midwestern hospital system compared alteplase administration in patients greater than 80 years of age to patients less than 80. Data examined included initial NIHSS, symptomatic hemorrhage rates, discharge disposition, and incidence of atrial fibrillation.

Results:
Comparisons (> 80 years vs. < 80 years) revealed: 1) 34% of patients treated with alteplase were greater than 80 years, 2) symptomatic hemorrhage rates were not statistically different (13% vs 8%, p=0.1904), 3) negative discharge outcomes (destination other than home or acute rehab) were more prevalent in the elder population (48% vs. 19%, p< .0001), 4) atrial fibrillation was more prevalent in elders (53%).

Conclusions:
Despite newer evidence, reluctance among practitioners to administer alteplase to the very elderly persists. In very elderly patients, retrospective data findings indicated that hemorrhage rates were not increased but short-term discharge outcomes were negatively impacted. This may be the result of the aging process and multiple comorbidities. Evaluation and dissemination of findings will emphasize to providers that this vulnerable population may still benefit from alteplase treatment.
Abstract T MP100: Improving Timeliness of TPA Administration: Re-vamping Emergency Department Processes to Decrease Door to Needle Times
Authors: Jurf Julie B , Hemmen Eema , Delima Tenielle , Virrey Eileen , Ojeda Linda , Morales Vera , Snyder Andrea G , Hemmen Thomas M
Published: July 2021

Introduction:
Time to neuroimaging is one of the critical measures for fast thrombolysis in acute ischemic stroke (AIS). While many aim to give IV tPA under 60 minutes from hospital arrival (door-to-needle or DTN), every minute of delay decreases the chances of good outcomes. Following previous reports, we established a streamlined triage system (STS) for all out-of-hospital stroke alerts and report on the initial experience of this new system and its effect on DTN.

Methods:
We included all AIS with last known well (LKW) under 2 hours who were treated with IV tPA from 11/2012 to 06/2014 at our facilities. We excluded telestroke or patients who were transferred to us, implemented STS on November 01, 2013 and analyzed time to CT (start of the exam) and DTN for patients before (group 1) after (Group 2) that date, using the UCSD GetWithTheGuidelines® data set. STS includes rapid triage on the EMS stretcher in the ED to assess patient safety for immediate transfer by EMS to CT, without a detailed neurological assessment. Previously patients were roomed in the ED first and received a triage including a neurological exam. We assessed treatment times, ED arrival to CT (DTC) and DTN for each Group and assessed serious neurological and medical complications (episodes of increased intracranial pressure, cardiac or respiratory arrest) in radiology before and after STS. We used unpaired t-test for comparing means (continuous variables).

Results:
A total of 36 patients received IV tPA (Group 1: 22, Group 2: 14). Mean (±SD) times (minutes) for DTC was 15.9(7.3) versus 11.5(6.5) (NS), for DTN 62.6(17.7) versus 53.8(19.6) (NS). We saw no serious complication before or after STS.

Conclusions:
Our streamlined stroke triage is safe and we aim to continue our analysis to identify additional opportunities for shorten treatment times. Expanding STS to include all stroke patients may further shorten DTN.
Abstract T MP11: Does Onset To Recanalization Time Influence The Effect Of Penumbra Pattern On Clinical Outcomes In Acute Ischemic Stroke Patients Receiving Endovascular Treatment?
Authors: Chung Jong-Won , Park Hong-Kyun , Yang Mi Hwa , Jang Myung Suk , Kim Beom Joon , Han Moon-Ku , Jung Cheolkyu , Kim Jae Hyoung , Oh Chang Wan , Bae Hee-Joon
Published: July 2021

Background:
Whether penumbra pattern (PP) can identify patients who are most likely to benefit from endovascular treatment (EVT) for acute ischemic stroke remains unclear. We aimed to establish whether onset to recanalization time modifies the effect of PP on outcomes of EVT. Methods: Based on a prospective stroke registry database, we identified patients with acute ischemic stroke who underwent perfusion and diffusion MRI before EVT, had anterior circulation stroke and received EVT within 12 hours of symptom onset, and whose recanalization was confirmed during EVT (mTICI ≥ 2b). Favorable PP was defined as predicted infarct core ≤ 70 ml, and a ratio between the volume of critically hypoperfused tissue (Tmax > 6s) and the ischemic core of 1.8 or more with their absolute difference of 15 mL or more. Onset to recanalization time was dichotomized by median value. Primary outcome was functional independence defined as a modified Rankin Scale score of 0 - 2 at 3 months. Safety outcome was symptomatic hemorrhagic transformation. Results: Among 72 eligible patients, the mean age was 44.0 years and median initial NIHSS score was 14 (IQR, 9 - 19). Favorable PP was detected in 58 patients (80.6%), and median onset to recanalization time was 233 min (range 180 - 371). Among all study subjects, the proportion of functional independence was higher in those with favorable PP compared to those without it (62.1% vs. 7.1%; OR, 21.27; 95% CI, 2.60 - 174.06; P < 0.001), but was not different between early and late recanalization groups (61.1% vs. 41.7%; OR, 2.20; 95% CI, 0.86 - 5.65; P = 0.099). Favorable PP was associated with functional independence in either early recanalization (75.0% vs. 12.5%; P = 0.003) or late recanalization groups (50.0% vs. 0%; P = 0.030). For functional independence, there was no interaction between the PP and onset to recanalization time (P = 0.751). No patients developed symptomatic hemorrhagic transformation. Conclusions: Contrary to previous knowledge, this retrospective analysis shows that favorable PP may predict functional independence independent of onset to recanalization time.
Abstract T MP41: Coronary Artery Calcification, Intima-media Thickness And Ankle-brachial Index Are Complementary Stroke Predictors
Authors: Gronewold Janine , Bauer Marcus , Lehmann Nils , Mahabadi Amir A , Kälsch Hagen , Weimar Christian , Berger Klaus , Moebus Susanne , Jöckel Karl-Heinz , Erbel Raimund , Hermann Dirk M ,   Heinz Nixdorf Recall Study Investigative Group
Published: July 2021

Background and Purpose:
Coronary artery calcification (CAC), a marker of coronary atherosclerosis, predicts stroke in addition to established risk factors. Whether CAC’s predictive value can be improved by peripheral atherosclerosis markers, namely carotid intima-media thickness (CIMT) and ankle-brachial index (ABI), was unknown.

Methods:
3289 participants of the population-based Heinz-Nixdorf-Recall study (45-75 years; 48.8% men) without previous stroke or coronary heart disease were evaluated for incident stroke over 9.0±1.9 years. CAC, CIMT and ABI were examined as stroke predictors.

Results:
Eighty-four strokes occurred during follow-up. In multivariable Cox proportional hazard regressions, CAC (hazard ratio[HR]=1.45[95%-confidence interval=1.11-1.88] per standard deviation (SD) increase in ln(CAC+1); SD=2.40), CIMT (1.34[1.08-1.66] per SD increase; SD=0.127mm) and ABI (1.55[1.32-1.82] per SD decrease; SD=0.148) were associated with stroke in addition to established risk factors. When combined with each other, ln(CAC+1)'s HR remained similar when CIMT (1.41[1.09-1.83]) was inserted into the multivariable model, but slightly decreased when ABI (1.31[1.01-1.72]) or CIMT and ABI (1.29[0.99-1.68]) were included. While CAC alone did not significantly elevate the area-under-the-curve (AUC) in Harrell's c-statistics (by 0.009; p=0.379) in addition to established risk factors, the combination of CAC and ABI increased AUC (by 0.029; p=0.047), as did ABI (by 0.025; p=0.038) but not CIMT (by 0.002; p=0.795) alone. The combination of CAC and ABI also resulted in significant category-free net reclassification and integrated discrimination improvement.

Conclusions:
CAC, CIMT and ABI provide complementary information about stroke risk. ABI, which is distinctive in a small subpopulation, had the highest and CIMT, which is distributed across a larger range of values, had the lowest predictive value.
Abstract T MP46: Stroke Occurrence in Hereditary Hemorrhagic Telangiectasia
Authors: Masilamani Kristopher D , LaBranche Jennifer , Malo Shaun , Svenson Larry , Jeerakathil Thomas , Vethanayagam Dilini
Published: July 2021

Purpose:
Stroke is an important manifestation of Hereditary Hemorrhagic Telangiectasia (HHT). Many individuals may be unaware they have HHT, even after a stroke, due to its rarity. Our goal was to assess the occurrence of stroke among patients with HHT compared to the general population.

Methods:
Population-based administrative health data on inpatient and ambulatory admissions were extracted for the period 1997 to 2012 in Alberta using ICD-9 and ICD-10 codes. We observed overall occurrence of strokes in the HHT population and subsequently analyzed the data by gender, specific age groups, and stroke subtypes. Then we compared our findings to stroke occurrence among the general population.

Results:
The age-standardized occurrence rate of stroke in HHT was about 450 [95% CI 276.4, 622.6] per 100,000 PY compared to 260 [95% CI 259.3, 262.1] per 100,000 PY in the general population. Less than 3% of strokes occurred under 30 years old in both groups. Although the majority of strokes occurred after 60 years of age, 23% of strokes in the general population occurred in the middle-aged group (31-60). The prevalence of HHT in Alberta is 1 in 3,800 and three times as many women were diagnosed with HHT than men by 2012.

Conclusion:
The prevalence of HHT in Alberta was considerably higher than the North American estimate (1 in 5,000). Individuals diagnosed with HHT were 1.73 times more likely to have a stroke than average, a statistically significant difference. Among the general population, a substantial number of strokes occurred in the middle-aged group. There is a higher probability of an underlying genetic component in strokes occurring before 60 years. For patients who have a stroke before 60 without a clear etiology, clinicians should consider evaluation for genetic disorders such as HHT. This is particularly true for males in whom there may be underdiagnosis of HHT.
Abstract T MP68: Validating the Association of Peripheral Monocyte Count with 30-Day Case-Fatality in Intracerebral Hemorrhage
Authors: Walsh Kyle B , Sekar Padmini , Langefeld Carl , Moomaw Charles J , Elkind Mitchell , James Michael L , Osborne Jennifer , Sheth Kevin , Woo Daniel , Adeoye Opeolu
Published: July 2021

Introduction:
Preclinical models suggest an inflammatory response mediated by monocytes may contribute to secondary injury after intracerebral hemorrhage (ICH). We recently found an association of absolute monocyte count (AMC) with 30-day case fatality following ICH. We sought to validate this finding in an independent cohort of ICH patients.

Hypothesis:
AMC is independently associated with 30-day case-fatality following ICH.

Methods:
The Ethnic/Racial Variations of ICH (ERICH) study is a prospective, multi-center, case-control study of ICH among Caucasian, Black, and Hispanic patients. In 241 adult patients with nontraumatic ICH within 24 hours of symptom onset, demographic information, Glasgow Coma Scale (GCS), ICH volume, 30-day case-fatality, total white blood cell (WBC) count, absolute neutrophil count (ANC), AMC, and hemoglobin concentration were determined. Participating centers were requested to obtain WBC differentials on the 30 most recently enrolled cases. After receiving data on 411 subjects, we excluded 170 subjects whose initial WBC was >24 hours from onset and in those where monocytes and neutrophils were not available, resulting in 241 cases for the analysis. Linear regression was used to evaluate factors associated with ICH volume (log transformed), and logistic regression for factors associated with 30-day case-fatality.

Results:
Mean age was 62.8 years (SD ± 14 years), 61.8% were men and 33.6% were Black. Median ICH volume was 9.7ml (IQR 4.3-26.7). After adjusting for patient age and initial hemoglobin, higher ANC (p= 0.001) and total WBC count (p=0.0005) were associated with larger ICH volume, whereas AMC was not (p=0.14). After adjusting for age, GCS, and ICH volume, baseline AMC was independently associated with higher 30-day case-fatality (OR 5.24, 95% CI 1.62-16.89, p=0.0056) whereas ANC (OR 0.85, CI 0.15-4.68, p=0.85) and WBC count (OR 0.58, CI 0.04-7.67, p=0.68) were not.

Conclusions:
In this independent cohort an association between higher admission monocytes and case fatality was corroborated independent of known clinical variables. This suggests a specific role of monocytes in secondary injury following ICH. Inflammatory and neuronal apoptotic pathways mediated by monocytes may be a target for neuroprotection in ICH.
Abstract T MP75: Facilities Available in Chinese Hospitals From China Stroke Research Network
Authors: Wang Chunjuan , Li Zixiao , Wang Yilong , Jiang Yong , Zhao Xingquan , Wang Yongjun
Published: July 2021

Background and Purpose:
Stroke is the first leading cause of death in China and millions of patients were admitted to various levels of hospitals each year. However, it is unknown how many of these hospitals are able to provide an appropriate level of care for stroke patients since the certification program of comprehensive stroke center (CSC) and primary stroke center (PSC) has not been initiated in China.

Method:
In 2012, we selected all 554 hospitals that joined into the China Stroke Research Network (CSRN) to start a survey. These hospitals were from 31 provinces or municipalities, covered nearly the entire Mainland China. A six-page questionnaire was sent to each of them to obtain the stroke facility information. We used the same criteria and definitions for CSC, PSC, and minimum level for any hospital ward (AHW) admitting stroke patients with that of the European Stroke Facilities Survey.

Results:
For all the hospitals in CSRN, 521 (94.0%) returned the questionnaire, 20 (3.8%) met criteria for CSC, 179 (34.4%) for PSC, 64 (12.3%) for AHW, and 258 (49.5%) met none of them and provided a lower level of care. Hospitals meeting criteria for CSC, PSC, AHW, and none of them admitted 70 052 (8.8%), 334 834 (42.2%), 88 364 (11.1%), and 299 806 (37.8%) patients in the whole of last year. There was no 24-hour availability for brain CT scan in 4.3% of hospitals not meeting criteria for AHW, while neither stroke care map nor stroke pathway for patients admission in 81.0% of them.

Conclusions:
Less than two fifths of Chinese hospitals admitting acute stroke patients have optimal facilities, and nearly half even the minimum level is not available. Our study suggests that only one half acute stroke patients are treated in appropriate centers in China, facilities for hospitals admitting stroke patients should be enhanced and certification project of CSCs and PSCs may be a feasible choice.
Abstract T MP81: Are 30-Day Stroke Readmissions Preventable?
Authors: Leonhardt Ann M , Benesch Curtis G
Published: July 2021

Introduction:
Stroke has a high risk of recurrence and known complications. The expected readmission rate and number of preventable readmissions are difficult to determine. We sought to identify preventable readmissions at an academic medical center in anticipation of CMS pay-for-performance inclusion of 30-day readmission rate as a quality measure.

Methods:
Fiscal year 2013 readmissions data were obtained from the Office of Clinical Practice Evaluation. Administrative readmissions were removed and individual chart reviews completed for NIHSS, clinical diagnosis at readmission, and potential contributing factors. Cases were evaluated by a Nurse Practitioner and Neurologist specializing in stroke to determine if the readmission was preventable. Consensus was reached on all cases.

Results:
The 30-day readmission rate was 7.47% with 48 readmissions in 46 patients. When compared to all ischemic stroke patients, the readmitted patients were younger (mean age 56 yrs vs 68 yrs) with higher LOS (median 8 days vs 4 days) and comparable NIHSS (mean 8.5 vs 8.8). Stroke or TIA accounted for 7 (14.6%) readmissions. Median number of days to readmission was 7.5, with 47.8% of readmissions occurring within 7 days. Case review determined 27 (56.3%) not to be preventable, 8% were questionable. Outpatient evaluation may have prevented 9 (18.8%), 6.3% were felt to be initial coding errors and should have been removed from the original sample; 10.4% (5) reflected care at the hospital level.

Conclusions:
Based on case reviews at our institution less than half of readmissions are preventable, with only about 10% reflecting aspects of a patient’s inpatient care. Categorizing preventable readmissions into administrative, hospital, or outpatient related will assist in development of a plan for readmission reduction. Through collaboration with health information management those patients with unclear coding will be reviewed and revised. Phone calls within 7 days for patients discharged home have increased in regularity. Future planning for participation in Medicare bundled payments for stroke may encourage more collaboration with SNF and Rehabilitation facilities, allowing for evaluation without hospital admission.
Abstract T MP83: Simulation Based Medical Education For Incoming Neurology Trainees to Improve Hospital Stroke Emergency Performance
Authors: Gill Rick , Star Michael , Golombievski Esteban , McCoyd Matthew , Ruland Sean
Published: July 2021

INTRODUCTION:
An ED-based “stroke code” demands timely decision making and prioritization of tasks by the stroke team neurologist while coordinating care with ED staff, radiology and pharmacists. Simulation-based medical education (SBME) focuses on obtaining clinical skills belonging to the psychomotor, cognitive and affective domains. SBME is superior to the traditional style of medical education and has shown improved outcomes of knowledge, skills and behaviors and moderate effects for patient-related outcomes in other emergency based scenarios including ACLS and procedure-based learning.

HYPOTHESIS:
To describe the rationale and design for a novel hospital based stroke simulation. SBME can improve stroke code efficiency particularly for inexperienced stroke team members.

METHODS:
Six incoming PG2 neurology residents participated in a pilot study using a high fidelity patient simulation of an acute ED-based stroke code at week 1 and 3 of orientation. The trainee independently managed every step from activation of the stroke pager including a focused patient assessment, ordering and interpreting labs and imaging, managing common obstacles, staffing with the on-call attending, working with ancillary staff and appropriate treatment as indicated. Residents completed an affective survey, pre- and post-test cognitive assessment and debriefing with feedback, as well as real time checklist and review of videotaped assessment of their performance.

RESULTS:
Subjects showed a 16.1% improvement in the cognitive assessment from week 1 to week 3 (p=0.02). The affective survey showed residents were moderate to highly confident in their ability to perform a history and physical prior to participation, yet they had low confidence utilizing the NIHSS and managing medications for acute stroke in the ED prior to participation.

CONCLUSION:
SBME can facilitate the acquisition of technical and non-technical skills such as leadership, team work, communication, situational awareness, decision-making, cognizance of personal limitations important for patient safety and a learning cycle of debriefing and feedback. Post-test and affective survey results demonstrate improvements in the cognitive domain and resident confidence respectively.
Abstract T P107: Change of Day-to-Day BP Variability and Perfusion Status in Acute Ischemic Stroke
Authors: Kang Jihoon , Bae Hee-Joon , Han Moon-Ku , Jang Min Uk , Hong Jeong-Ho , Lee Ji Sung
Published: July 2021

Purpose:
We investigated how BP is changed over elapsed time according to the perfusion status at acute stage of ischemic stroke.

Methods:
Patients arrived within 24 hours of symptom onset and have symptomatic occlusion at MCA and ICA were consecutively identified. Among them, we included those were not eligible or failed for recanalization therapy at acute stage. According to the occluded site and perfusion lesion volume, they were dichotomized into upper one-third (large PLV) and others (small-to-medium PLV). For the first consecutive 5 days, daily BP parameters of followings: mean, maximum-minimum and standard deviation (SD) between groups were compared using repeated measures ANOVA.

Results:
Of enrolled 129 subjects (mean age, 69.3 ± 12.7 years-old and median NIHSS score, 6), cut-offs of large PLV were 143 ml for MCA and 232 ml for ICA. At the day of hospital arrival, mean, maximum-minimum and SD of systolic BP were 136.8, 55.6 and 14.4 mmHg and those at 5th day were 136.2, 32.9 and 11.8 mmHg, respectively. Patients with large PLV were significantly associated with higher maximum-minimum and SD compared to those with small-to-medium PLV (P < 0.001) not averaged value with adjustments for age and baseline NIHSS score (Figure 1).

Conclusion:
Perfusion status at acute stage of ischemic stroke would be related with day-to-day change of BP variability.
Abstract T P114: Insulin Resistance in Skeletal Muscle of Chronic Stroke
Authors: Ryan Alice S , Ortmeyer Heidi , Ivey Frederick , Hafer-Macko Charlene
Published: July 2021

Risk of glucose intolerance and diabetes increases in chronic stroke. The purpose of this study was to assess insulin sensitivity and glycogen synthase (GS), a known benchmark index of insulin action in skeletal muscle, and to compare the activity of this important regulatory enzyme between paretic (P) and non-paretic (NP) skeletal muscle in chronic stroke. We measured insulin sensitivity (M) and bilateral GS fractional activity (ratio of independent to total activity), in lyophilized microdissected muscle samples obtained after an overnight fast and 2 hrs into a 3-hr 80 mU
.
m
-2.
min
-1
hyperinsulinemic-euglycemic clamp in 21 stroke survivors (n=15 men, n=6 women) (age: 59±2 yrs, BMI: 31±2 kg/m
2
, X±SEM). All had hemiparetic gait after ischemic stroke (>6 months), low aerobic capacity (VO
2
peak, 19.7±1.3 ml/kg/min), and wide range of %body fat (11-48%). Leg lean mass was lower in P than NP (9.3±0.5 vs. 10.0±0.5 kg, P<0.001). Subjects had either normal glucose tolerance (n=7), impaired glucose tolerance (n=7), or diabetes (n=7) and insulin resistance (M: 38.5±2.6 umol/kgFFM/min). Insulin robustly increased GS fractional activity (basal vs. insulin) in P (2.8±0.4 vs.7.5±0.8%, P<0.00001) and NP (2.7±0.4 vs. 9.1±1.1%, P<0.00001) muscle. The %change was greater in NP than P (213±32 vs. 296±36%, P=0.04). The effect of in vivo insulin to increase GS fractional activity was associated with M in P and NP muscle (r=0.59 and r=0.49, P<0.05). In conclusion, muscle atrophy and a reduction in insulin action in paretic muscle likely contribute to whole body insulin resistance in chronic stroke.
Abstract T P12: Intraarterial (IA) Iodinated Radiographic Contrast Media (IRCM) Effect in the Interventional Management of Stroke (IMS) III Trial
Authors: Tomsick Thomas , Foster Lydia D , Yeatts Sharon D , Hill Michael D , Carrozzella Janice , Liebeskind David S , Khatri Pooja , Goyal Mayank , Puetz Volker , Dzialowski Imanuel , Morales Humberto , Demchuk Andrew M , Palesch Yuko Y , Broderick Joseph P
Published: July 2021

Background:
IRCM have variable anti-thrombotic, fibrinolytic, cytotoxic, hydrostatic, and vasoactive effects. IA low-osmolar iohexol (~700 mOsm/L) was associated with increased ICH in a rat MCA occlusion model compared to saline infusion. IA isosmolar iodixanol (280 mOsm/L) was associated with smaller infarcts and less ICH versus low-osmolar iopamidol and saline. Reduced odds of favorable outcome in patients receiving IV IRCM prior to IV rtPA has been suggested. No human stroke study has compared outcomes according to IA IRCM use.

Methods:
133 IMS III subjects underwent endovascular therapy (EVT) for M1 occlusion. mTICI 2B-3 reperfusion, 90-day mRS 0-2, asymptomatic ICH, symptomatic ICH, and 90-day mortality were analyzed according to use of either iso-osmolar iodixanol (n=31) or low-osmolar IRCM (n=102). Separate adjusted models were fit for each outcome. Variables imbalanced between IRCM types or associated with outcome (p<0.1) were considered potential covariates for adjusted models, including antiplatelet medication (67.7% iodixanol vs. 44.1%, p=0.021), coronary artery disease history (35.5% iodixanol vs. 19.6%, p=0.067) and age (iodixanol median 73 vs. 68.5 yrs, p=0.070). Adjusted relative risks were estimated using a log-link regression model following stepwise selection of covariates.

Results:
% Differences for all specified outcomes in favor of the iodixanol group were identified. None of 11 baseline or EVT variables linked to outcome was in favor of the iodixanol group (p < 0.3). Unadjusted and adjusted relative risk point estimates were in favor of the iodixanol group for all specified outcomes (Table).

Conclusion:
While there were no significant differences, relative risk point estimates for relevant specified endpoints for M1 occlusion are in favor of iodixanol use. Small sample size limits ability to show significant differences. Data remains hypothesis-generating. Potential mechanisms warrant further investigation.
Abstract T P124: Psychometric Properties of the Chinese Version of the Stroke Specific Quality of Life Scale in Community-Dwelling Stroke Survivors
Authors: Lo Suzanne H , Chang Anne M , Chau Janita P , Gardner Glenn E
Published: July 2021

Introduction:
Health-related quality of life is a significant outcome of stroke survivors’ recovery. The 49-item English version of the Stroke Specific Quality of Life Scale (SSQOL) (Williams et al., 2009) is a stroke-specific assessment of stroke survivors’ health-related quality of life in 12 domains. However there has been no Chinese version of the scale for Chinese stroke survivors in Hong Kong.

Aim:
To examine the reliability and validity of the Chinese version of Stroke Specific Quality of Life Scale (SSQOL-C) in stroke survivors.

Methods:
SSQOL was translated into Chinese and blind back-translated by independent bilingual baccalaureate nursing students. Content validity was reviewed by an expert panel which consisted of one nurse academic, one nurse manager, three advanced practice nurses, and two registered nurses. A cross-sectional study was conducted to validate the translated version. A convenience sample of 135 adult stroke survivors were recruited from three community centres and a stroke support group in Hong Kong. Internal consistency analysis was performed. Pearson’s correlation coefficients were calculated between SSQOL-C, SF-36, and Frenchay Activities Index (FAI) to determine the convergent validity.

Results:
Content validity index of SSQOL-C was 0.99. SSQOL-C had high internal consistency with Cronbach’s alpha of 0.94 for the total scale, and between 0.65 and 0.90 for the 12 domains. The total SSQOL-C scores showed significant positive correlations with SF-36 physical health (r=0.58, p<0.01) and mental health (r=0.54, p<0.01) component scores, and FAI score (r=0.59, p<0.01). SSQOL-C physical subtotal scores showed significant positive correlations with SF-36 physical health (r=0.55, p<0.01) and mental health (r=0.43, p<0.01) component scores, and FAI score (r=0.54, p<0.01). SSQOL-C psychosocial subtotal scores showed significant positive correlations with SF-36 physical health (r=0.52, p<0.01) and mental health (r=0.56, p<0.01) component scores, and FAI score (r=0.56, p<0.01).

Conclusion:
The results showed SSQOL-C had good content and convergent validity, and reliability in Chinese stroke survivors. Further evaluation of factor structure of SSQOL-C will be conducted to determine its validity.
Abstract T P127: Look Past the NIHSS! Rehabilitation Metrics that Predict Home Discharge in Ischemic Stroke Patients
Authors: Ifejika Nneka , Aramburo-Maldonado Linda , Cai Chunyan , Sline Melvin R , Noser Elizabeth A , Wang Jing , Grotta James C , Savitz Sean I
Published: July 2021

Introduction:
The goals of stroke rehabilitation are to restore functional ability and to return patients' home with a good quality of life. There is a paucity of data on stroke rehabilitation tools that both track improvements and help predict the likelihood of home discharge.

Hypothesis:
Improvement in functional independence measure (FIM) score increases home discharge rates, decreases acute care readmissions and decreases placement in skilled nursing facilities (SNF). Advanced age and infections such as symptomatic UTI (SUTI) negate FIM score improvement.

Methods:
We merged the prospectively collected Stroke and Neurorehabilitation Registries at our comprehensive stroke center, identifying ischemic stroke patients admitted between January 2011 and November 2013 (n=367). Demographics, rehabilitation metrics and NIHSS were collected. Age, SUTI, discharge FIM and rehabilitation length of stay (LOS Rehab) were included in the multivariate regression.

Results:
Of 367 ischemic stroke patients, 273 went home, 47 to a SNF, 25 to acute care and 22 to another facility (i.e.,assisted living, board and care). All patients tolerated 3 hours of daily therapy (PT, OT, SLP).

Despite median NIHSS values of 9 in both groups (P=0.356), patients with SUTI had lower FIM scores on admission (49.2 ± 13.9 vs. 56.8±15.2; P<0.0001) and discharge (68.5 ± 16.9 vs. 76.3 ± 17.0; P<0.0001).

For a one year age increase, there was a 5% increase in SNF admit (OR 1.05, 95%CI 1.02-1.08; P<0.001) compared to home.

For a one unit increase in FIM, there was a 4% decrease in another facility admit (OR 0.96, 95% CI 0.93 to 0.99; P<0.01), a 6% decrease in SNF admit (OR 0.94, 95%CI 0.92-0.96; P<0.001) and a 10% decrease in acute care readmit (OR 0.90, 95% CI 0.88-0.94; P<0.0001) compared to home.

For a one day increase in LOS Rehab, there was a 19% decrease in acute care readmit (OR 0.81, 95% CI 0.73-0.89; P<0.0001) compared to home, and a 7% increase in home discharge compared to another facility (OR 1.07, 95% CI 1.02 to 1.12; P<0.001).

Conclusions:
Improved FIM score and increased LOS Rehab were the primary criteria for home discharge after stroke rehabilitation. Advanced age increased the likelihood of SNF placement. SUTI impacted rehabilitation progress, but did not affect discharge to home.