Targeted versus High-Intensity Monitoring Following Intravenous Thrombolysis in Acute Ischemic Stroke
Carl-Lewis Valcinord1, Sohum Bindra2, Jodi Mueller2, Marcus Millani2, Megan Tessmer2, Christopher Streib3, Abbey Staugaitis2
1Neurology, University of Minnesota, 2University of Minnesota, 3Department of Neurology
Objective:
We studied a targeted-intensity monitoring (TIM) protocol for low-risk acute ischemic stroke (AIS) patients following IVT.
Background:
Conventional high-intensity monitoring (HIM) post-intravenous thrombolysis (IVT) is resource-intensive and of unclear utility in low-risk AIS patients.
Design/Methods:
Low-risk post-IVT AIS patients (NIHSS≤10, BP<180/105, no high-risk stenosis/occlusion, preserved level of consciousness) between 10/2020-4/2024 were included. The HIM protocol was utilized in the ICU until March 2022, thereafter TIM was utilized in the intermediate care unit (IMC). HIM protocol vital sign monitoring and neurochecks occurred q15 minutes for 2 hours, q30 minutes for 6 hours, then q1 hour for 16 hours (72 total assessments); TIM protocol vital sign monitoring and neurochecks occurred q15 minutes for one hour, q1 hour for three hours, q2 hours for 8 hours, then q4 hours for 12 hours (28 total assessments). We examined the frequency TIM patients were transferred to the ICU, ICU length of stay, hospital length of stay, symptomatic intracranial hemorrhage (sICH), and early neurologic deterioration (END [NIHSS increase ≥4]). Statistical testing was performed using chi-squared tests and two sample t-test.
Results:
95 patients were included: 47 HIM (median age 71 [IQR 56-75.5], median NIHSS 4) and 48 TIM (median age 65, [IQR 60-81.25], median NIHSS 4). The mean ICU stay for HIM was 32.8 hours; no TIM patients were transferred from IMC to ICU. There was no difference in sICH: HIM 2.1% vs. TIM 0% (p=0.31); median hospital length of stay: HIM 49.8 hours (IQR: 43.8-83.3) vs TIM 49.6 hours (IQR: 32.6-99.7) (p=0.716), END: HIM 0% vs TIM: 2.1% (p=0.320).
Conclusions:
A post-IVT TIM protocol was feasible and safe in selected post-IVT AIS patients. TIM protocols may conserve healthcare resources and increase ICU bed availability.
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