Abstract 79: Pre-hospital Diagnosis in Mobile Stroke Treatment Unit

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Abstract

Introduction: Mobile stroke treatment unit (MSTU) has been shown to be able to provide pre-hospital thrombolysis in acute ischemic stroke (AIS). MSTU can also be used for early pre-hospital diagnosis and treatment of other neurological diseases.

Hypothesis: MSTU encounters neurological disorders other than AIS that needs emergent treatment.

Methods: We obtained pre-hospital diagnosis and treatment data from the prospectively collected dataset on 231 consecutive MSTU encounters. Based on initial clinical evaluation and neuroimaging obtained on MSTU, the stroke physician made the diagnosis of AIS (definite, probable, and possible AIS, transient ischemic attack), intracranial hemorrhage, and unlikely AIS. Non-stroke diagnosis made by MSTU physician was compared with final hospital discharge diagnosis.

Results: From July 2014 to May 2015, 231 patients were treated on MSTU of which 84 (36%) had clinical diagnosis of definite/probable AIS, 70 (31%) had possible AIS, while 14 (6%) patients had intracranial hemorrhage. Sixty-three (27%) were diagnosed as unlikely AIS including 23 (10%) metabolic encephalopathy, 19 (8%) seizures (including 1 partial status epilepticus), 16 (7%) migraines, 16 (7%) substance abuse, 6 (3%) CNS tumor, 5 (2%) infectious etiology and 3 (1%) hypoglycemia. Thirty-three (14%) patients received non-thrombolytic treatments on MSTU including anti-hypertensives (24), anti-epileptic medications (7), coagulopathy reversal (1), and mannitol (1). In patients with initial diagnosis of possible AIS, final diagnoses were 29 AIS and 25 non-strokes, while in patients initially diagnosed with unlikely AIS, 5 were AIS and 38 were non-strokes in the final discharge diagnosis.

Conclusion: About a third of MSTU encounters were deemed not AIS initially, including intra cranial hemorrhage and seizure. MSTU can also be utilized to provide early pre-hospital treatments in emergent neurological conditions other than AIS.

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