# Acute Stroke in the Emergency Department: Profiles of Patients and Obstacles to Acute Intervention

## TL;DR

This study examines stroke patients in emergency departments, highlighting delays in treatment and differences between stroke types.

## Contribution

The study provides a detailed demographic and intervention profile of stroke patients in an emergency setting.

## Key findings

- Only 5.5% of stroke patients presented within the 'golden hour' for acute intervention.
- Hemorrhagic stroke patients were more likely to be intubated compared to ischemic stroke patients.
- A small proportion of ischemic stroke patients received thrombolysis despite being within the treatment window.

## Abstract

Aims: To build a demographic profile of patients presenting to the emergency department (ED) with stroke, determine the proportion who successfully undergo thrombolysis and active interventions, and study their outcomes up to discharge or death in the hospital.

Methods and materials: A sample size of 215 was calculated and patients were recruited consecutively on presentation to the ED after obtaining consent. Data was collected and they were followed up till the outcome. Data was tabulated and analyzed both as a whole and after further categorization into infarction, hemorrhagic stroke, and cerebral venous thrombosis (CVT). Mean and standard deviation were used for continuous variables and chi-square for categorical variables.

Results: A total of 216 patients were recruited, 156 (72%) male and 60 (28%) female. There were 135 (63%) ischemic strokes, 67 (31%) hemorrhagic, and 14 (6%) CVT. The mean age was 56.57 years (SD 14.22 years). A total of 12 patients (5.5%) presented within the ‘golden hour’ and 28 ischemic strokes presented within the thrombolysis window, of which nine were thrombolyzed. In total, 39 patients were intubated in the ED, of which 10 (7.41%) had ischemic strokes, 27 (40.3%) had hemorrhagic strokes and two (14.29%) had CVTs. There were 192 patients admitted to in-patient care, while 24 (11%) were discharged against medical advice. A further 14 patients were intubated during admission. Nine patients (13.43%) with hemorrhagic strokes underwent surgical decompression, five (7.46%) had an external ventricular drain (EVD) placed, six (8.96%) underwent aneurysm clipping, and two (2.99%) underwent aneurysm coiling. One case of CVT underwent surgical decompression.

Conclusions: Stroke is a highly heterogeneous clinical entity with nuanced differences between the different subtypes. There appear to be significant obstacles regarding the early presentation of strokes to hospitals and the initiation of thrombolysis in the case of acute interventions.