Introduction: Rapid response teams (RRTs) are a way to provide rapid assessment and early intervention for inpatients with clinical deterioration, including those with acute stroke. The goal of this study is to examine the accuracy and outcomes of inpatient stroke code RRT activations within a hospital system.
Methods: A retrospective chart review was performed for all RRT activations called for inpatient stroke codes within the UC San Diego Healthcare System from January 1, 2014 to November 30, 2015. Relevant variables included: clinical symptoms at the time of RRT initiation, neuroimaging modality (CT, CTA, MRI), IV rt-PA and/or endovascular therapy (ET), event diagnosis, and discharge disposition. We compared patients with diagnosis of stroke (AIS, ICH, SAH, other) versus non-stroke diagnosis. Diagnosis was determined by independent adjudication of provider documentation and corresponding acute and follow-up neuroimaging.
Results: 285 of 2336 (12.2%) RRT activations were for stroke code. Ultimately, 31.2% (n=89) were diagnosed with stroke (61 AIS [68.5%], 17 ICH [19.1%], 2 SAH [2.3%], 2 epidural [2.3%] and 7 subdural hematomas [7.9%]). Of stroke codes, neuroimaging was used more often in patients diagnosed with stroke including CT (97.8% vs 89.3%, p=0.03), CTA (42.7% vs 29.6%, p=0.04), and MRI (28.1% vs 16.3%, p=0.03). Discharge disposition was home in 18.0% vs. 36.2% (p=0.001), skilled nursing facility in 22.5% vs. 27.6% (p=0.001), and inpatient rehabilitation in 11.2% vs. 3.6% (p=0.001). In-hospital mortality was higher in those with stroke (22.5% vs 10.7%, p=0.001). Only 18 patients (6.3%) received acute recanalization therapies (4 IV rt-PA, 12 ET, 2 both).
Conclusions: Relatively few RRT stroke code activations diagnosed acute stroke and few received IV rt-PA and ET. Further studies are needed to better quantify the benefit of RRT in stroke code, explore additional benefits beyond acute recanalization therapies, and consider more targeted assessment for better resource utilization.