ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria

Nick M. Murray, Michael Ke, Alan Yee, Charlene Chen, Christine Wong, Ann Bedenk, J. Fernandes, Nobl Barazangi, D. Tong

Research output: Contribution to journalArticle

Abstract

Background and Objective: Current standard practice guidelines recommend ICU admission for ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). More recently, the trend in stroke care is to broaden eligibility for IV thrombolysis. Two examples are a more liberal inclusion criteria known as SMART criteria (sIV-tPA), and the transfer of patients to comprehensive stroke centers (CSC). The present study characterizes ICU interventions in these patients. Understanding which stroke patients that require ICU-level care may allow for placement of patients in the appropriate level of care at hospital admission. Methods: We performed a retrospective review of consecutive transfer and nontransfer sIV-tPA-treated patients admitted to the ICU at a CSC. We evaluated the frequency, timing, and nature of ICU interventions. Results: Three hundred and thirty one patients were treated with sIV-tPA and 42% required ICU interventions during ICU admission. Of patients requiring ICU interventions, 98% had an ICU intervention performed in triage, prior to admission. National Institute of Health Stroke Scale score only had a moderate association to requirement of ICU interventions. Neither transferring patients to a CSC nor the number of standard IV-tPA contraindications increased ICU interventions. Conclusions: Liberalized IV-tPA administration did not increase ICU interventions. Nearly all patients that required ICU interventions declared this need in triage, prior to ICU admission. This timing of ICU intervention use during triage is highly sensitive for whether a patient will require ongoing ICU-level care during hospital admission. Identifying ICU intervention use in triage may allow for more effective placement of post–IV-tPA patients in the appropriate inpatient care setting, leading to better utilization of scarce ICU resources.

Original languageEnglish (US)
Pages (from-to)2488-2495
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume28
Issue number9
DOIs
StatePublished - Sep 2019

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Tissue Plasminogen Activator
Stroke
Triage
Patient Transfer
National Institutes of Health (U.S.)
Practice Guidelines
Inpatients

Keywords

  • Admission decisions—predictors of ICU needs—tissue plasminogen activator—ischemic stroke—intensive care unit

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria. / Murray, Nick M.; Ke, Michael; Yee, Alan; Chen, Charlene; Wong, Christine; Bedenk, Ann; Fernandes, J.; Barazangi, Nobl; Tong, D.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 28, No. 9, 09.2019, p. 2488-2495.

Research output: Contribution to journalArticle

Murray, Nick M. ; Ke, Michael ; Yee, Alan ; Chen, Charlene ; Wong, Christine ; Bedenk, Ann ; Fernandes, J. ; Barazangi, Nobl ; Tong, D. / ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria. In: Journal of Stroke and Cerebrovascular Diseases. 2019 ; Vol. 28, No. 9. pp. 2488-2495.
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abstract = "Background and Objective: Current standard practice guidelines recommend ICU admission for ischemic stroke patients treated with intravenous tissue plasminogen activator (IV-tPA). More recently, the trend in stroke care is to broaden eligibility for IV thrombolysis. Two examples are a more liberal inclusion criteria known as SMART criteria (sIV-tPA), and the transfer of patients to comprehensive stroke centers (CSC). The present study characterizes ICU interventions in these patients. Understanding which stroke patients that require ICU-level care may allow for placement of patients in the appropriate level of care at hospital admission. Methods: We performed a retrospective review of consecutive transfer and nontransfer sIV-tPA-treated patients admitted to the ICU at a CSC. We evaluated the frequency, timing, and nature of ICU interventions. Results: Three hundred and thirty one patients were treated with sIV-tPA and 42{\%} required ICU interventions during ICU admission. Of patients requiring ICU interventions, 98{\%} had an ICU intervention performed in triage, prior to admission. National Institute of Health Stroke Scale score only had a moderate association to requirement of ICU interventions. Neither transferring patients to a CSC nor the number of standard IV-tPA contraindications increased ICU interventions. Conclusions: Liberalized IV-tPA administration did not increase ICU interventions. Nearly all patients that required ICU interventions declared this need in triage, prior to ICU admission. This timing of ICU intervention use during triage is highly sensitive for whether a patient will require ongoing ICU-level care during hospital admission. Identifying ICU intervention use in triage may allow for more effective placement of post–IV-tPA patients in the appropriate inpatient care setting, leading to better utilization of scarce ICU resources.",
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