P1049Bedside echocardiography after stroke to shorten hospitalization length and to screen candidates for invasive transoesophageal evaluation.


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Abstract

Background: About 30% of transient ischemic attacks (TIA)/strokes have cardioembolic origin, and echocardiography is widely applied for detection of cardioembolic sources. Hand Held Echocardiographic devices (HHE) can be used for bedside evaluation of patients (pts) in variuos clinical conditions. AIM:To assess the efficiency of HHE in detecting the sources of cardiac embolism in pts affected by TIA/stroke and to test the cost-saving and time-saving effect of HHE in diagnosis and treatment of those pts.Methods: In a six-month period, two groups of patients affected by TIA/stroke were evaluated either by standard echocardiography (SE, 117 pts) or by HHE (70 pts). The number of days from request to performance of echocardiography ("waiting-time") and the mean length of hospitalization, as well as the global cost of hospitalization were analysed according to SAS proc freq and proc Ttest, and with regression models for dependent variables. The influence of age, sex and comorbidities (systemic hypertension and diabetes mellitus) on the results was also tested. When transoesophageal echocardiography (TOE) was needed, its effect on global cost was also assessed.Results: Mean hospitalization length was reduced by the use of HHE, as were the mean waiting-time for performance of echocardiography and global hospitalization cost. Age, sex and comorbidities did not affect the results. Even in the need of further evaluation with TOE because of lower prognostic power of HHE (9/70 pts), hospitalization length was shorter for the HHE group, as was the total cost of hospitalization paid by the hospital (p < 0,0001) compared to SE group.Conclusions: The use of HHE in Neurology department as first, rapid screening-tool to detect the sources of cardiac embolism allows the selection of pts in need of further cardiologic assessment by invasive approach (TOE) from patient without evident cardiac disease, and at the same time shortens hospitalization length by reducing the time between request and performance of echocardiography.

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