Roland Faigle1, Jaime Butler1, Juan R Carhuapoma2, Brenda Johnson1, Elizabeth K Zink3, Tenise Shakes3, Melissa Rosenblum3, Mustapha Saheed4, Victor C Urrutia1. 1. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Division of Neurosciences Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, MD, USA. 3. Department of Neuroscience Nursing, The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, MD, USA. 4. Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
Abstract
BACKGROUND AND PURPOSE: At present, stroke patients receiving intravenous thrombolysis (IVT) undergo monitoring of their neurological status and vital signs every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, and every hour thereafter up to 24 hours post-IVT. The present study sought to prospectively evaluate whether post-IVT stroke patients with low risk for complications may safely be cared for utilizing a novel low-intensity monitoring protocol. METHODS: In this pragmatic, prospective, single-center, open-label, single-arm safety study, we enrolled 35 post-IVT stroke patients. Adult patients were eligible if their NIH Stroke Scale (NIHSS) was less than 10 at the time of presentation, and if they had no critical care needs by the end of the IVT infusion. Patients underwent a low-intensity monitoring protocol during the first 24 hours after IVT. The primary outcome was need for a critical care intervention in the first 24 hours after IVT. RESULTS: The median age was 54 years (range: 32-79), and the median pre-IVT NIHSS was 3 (interquartile range [IQR]: 1-6). None of the 35 patients required transfer to the intensive care unit or a critical care intervention in the first 24 hours after IVT. The median NIHSS at 24 hours after IVT was 1 (IQR: 0-3). Four (11.4%) patients were stroke mimics, and the vast majority was discharged to home (82.9%). At 90 days, the median NIHSS was 0 (IQR: 0-1), and the median modified Rankin Scale was 0 (range: 0-6). CONCLUSION: Post-IVT stroke patients may be safely monitored in the setting of a low-intensity protocol.
BACKGROUND AND PURPOSE: At present, stroke patients receiving intravenous thrombolysis (IVT) undergo monitoring of their neurological status and vital signs every 15 minutes for the first 2 hours, every 30 minutes for the next 6 hours, and every hour thereafter up to 24 hours post-IVT. The present study sought to prospectively evaluate whether post-IVT stroke patients with low risk for complications may safely be cared for utilizing a novel low-intensity monitoring protocol. METHODS: In this pragmatic, prospective, single-center, open-label, single-arm safety study, we enrolled 35 post-IVT stroke patients. Adult patients were eligible if their NIH Stroke Scale (NIHSS) was less than 10 at the time of presentation, and if they had no critical care needs by the end of the IVT infusion. Patients underwent a low-intensity monitoring protocol during the first 24 hours after IVT. The primary outcome was need for a critical care intervention in the first 24 hours after IVT. RESULTS: The median age was 54 years (range: 32-79), and the median pre-IVT NIHSS was 3 (interquartile range [IQR]: 1-6). None of the 35 patients required transfer to the intensive care unit or a critical care intervention in the first 24 hours after IVT. The median NIHSS at 24 hours after IVT was 1 (IQR: 0-3). Four (11.4%) patients were stroke mimics, and the vast majority was discharged to home (82.9%). At 90 days, the median NIHSS was 0 (IQR: 0-1), and the median modified Rankin Scale was 0 (range: 0-6). CONCLUSION: Post-IVT stroke patients may be safely monitored in the setting of a low-intensity protocol.
Authors: D Strbian; A Meretoja; F J Ahlhelm; J Pitkäniemi; P Lyrer; M Kaste; S Engelter; T Tatlisumak Journal: Neurology Date: 2012-02-07 Impact factor: 9.910
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2014-01-21 Impact factor: 29.690
Authors: J Braimah; G Kongable; K Rapp; S Daley; P Bratina; S Sailor; C Barch; R Donnarumma; J Spilker Journal: J Neurosci Nurs Date: 1997-12 Impact factor: 1.230
Authors: Eric E Smith; Gregg C Fonarow; Mathew J Reeves; Margueritte Cox; Daiwai M Olson; Adrian F Hernandez; Lee H Schwamm Journal: Stroke Date: 2011-09-08 Impact factor: 7.914
Authors: Edward C Jauch; Jeffrey L Saver; Harold P Adams; Askiel Bruno; J J Buddy Connors; Bart M Demaerschalk; Pooja Khatri; Paul W McMullan; Adnan I Qureshi; Kenneth Rosenfield; Phillip A Scott; Debbie R Summers; David Z Wang; Max Wintermark; Howard Yonas Journal: Stroke Date: 2013-01-31 Impact factor: 7.914
Authors: M Köhrmann; T Nowe; H B Huttner; T Engelhorn; T Struffert; R Kollmar; M Saake; A Doerfler; S Schwab; P D Schellinger Journal: Cerebrovasc Dis Date: 2008-12-18 Impact factor: 2.762
Authors: Werner Hacke; Geoffrey Donnan; Cesare Fieschi; Markku Kaste; Rüdiger von Kummer; Joseph P Broderick; Thomas Brott; Michael Frankel; James C Grotta; E Clarke Haley; Thomas Kwiatkowski; Steven R Levine; Chris Lewandowski; Mei Lu; Patrick Lyden; John R Marler; Suresh Patel; Barbara C Tilley; Gregory Albers; Erich Bluhmki; Manfred Wilhelm; Scott Hamilton Journal: Lancet Date: 2004-03-06 Impact factor: 79.321
Authors: David T Winkler; Felix Fluri; Peter Fuhr; Stephan G Wetzel; Philippe A Lyrer; Stephan Ruegg; Stefan T Engelter Journal: Stroke Date: 2009-01-22 Impact factor: 7.914
Authors: Aakriti Gupta; Mahesh V Madhavan; Kartik Sehgal; Nandini Nair; Shiwani Mahajan; Tejasav S Sehrawat; Behnood Bikdeli; Neha Ahluwalia; John C Ausiello; Elaine Y Wan; Daniel E Freedberg; Ajay J Kirtane; Sahil A Parikh; Mathew S Maurer; Anna S Nordvig; Domenico Accili; Joan M Bathon; Sumit Mohan; Kenneth A Bauer; Martin B Leon; Harlan M Krumholz; Nir Uriel; Mandeep R Mehra; Mitchell S V Elkind; Gregg W Stone; Allan Schwartz; David D Ho; John P Bilezikian; Donald W Landry Journal: Nat Med Date: 2020-07-10 Impact factor: 53.440
Authors: Enrique C Leira; Andrew N Russman; José Biller; Devin L Brown; Cheryl D Bushnell; Valeria Caso; Angel Chamorro; Claire J Creutzfeldt; Salvador Cruz-Flores; Mitchell S V Elkind; Pierre Fayad; Michael T Froehler; Larry B Goldstein; Nicole R Gonzales; Brian Kaskie; Pooja Khatri; Sarah Livesay; David S Liebeskind; Jennifer J Majersik; Asma M Moheet; Jose G Romano; Nerses Sanossian; Lauren H Sansing; Brian Silver; Alexis N Simpkins; Wade Smith; David L Tirschwell; David Z Wang; Dileep R Yavagal; Bradford B Worrall Journal: Neurology Date: 2020-05-08 Impact factor: 9.910
Authors: Roland Faigle; Bridget J Chen; Rachel Krieger; Elisabeth B Marsh; Ayham Alkhachroum; Wei Xiong; Victor C Urrutia; Rebecca F Gottesman Journal: Neurology Date: 2021-03-31 Impact factor: 11.800