253 A registry of current practice to improve the care of stroke patients in Haute Garonne

Objectives A stroke is an emergency that must be investigated early and rapidly to find the cause and give appropriate treatment. When a stroke is suspected it is recommended in the first instance to call the medical emergency telephone centre (Centre 15). The aim of this registry was to study the emergency care managment followed for suspected stroke patients and to evaluate the impact of the recourse to the Centre 15 Program In April 2008 a registry of current practice was established by the Observatoire Regional des Urgences de Midi-Pyrenees within all the public emergency services of the Haute Garonne. All patients over the age of 18 suspected or having an acute stroke were included by the call-centre of the prehospital (SAMU31, SMUR) or the emergency services. The current evaluation concerns the patients taken care of by the St Gaudens Hospital Centre (SMUR and emergency department) over a period of 15 months. This establishment covers a population catchment9s of 75 000 inhabitants and is situated in the south of the Department, one hour from the Toulouse University Hospital which houses the neurovascular unit and the SAMU. The St Gaudens Hospital Centre has a CT scan but no neurological specialist. Results Two hundred twenty six patients were included in the study between the 1st of April 2008 and the 30th of June 2009. They had a mean age of 79 (range 32-97) and a sex ratio of 0.45. The completion rate was 100%. Fifty eight per cent of the patients were stabilised by the SAMU31, either as a result of a direct call to the centre 15 or after contact made by an independent doctor, and of these patients 9.3 % were taken by the SMUR in St Gaudens. Among the patients arriving directly at the emergency department (ED) without prior stabilisation (42 %), 56 % had contacted an independent doctor in the first instance. The median delay ‘onset of symptoms—arrival at the ED’ for all patients was 151 min (range 86–352). It was shorter (146 vs 155 min; p=0.67) for stabilised patients. The median length of time in the ED was 210 min overall and was shorter for the stabilised patients (190 vs 239 min; p=0.06). The delay between arriving in ED and clinical examination was significantly shorter for stabilised patients (11 vs 26 min; p Discussion The registry enables the care systems to be objectively compared and our results confirm the positive clinical impact of an intervention following a call to the centre 15: a shorter time in emergency and earlier treatment. The gain in time is estimated to be 15 min, which enables the rate of patients eligible for thrombolysis to be increased. However, only 58% of patients follow this route. This record will enable us to evaluate the impact of (1) setting up information campaigns on the rate of initial calls to the centre 15 and (2) the prognosis (Rankin score) after 3 months. Conclusion The results show that there is a gain in time in the care of emergency stroke patients when the emergency telephone number 15 is used. Our immediate goal is to reinforce the information given to the public and general practitioners to increase the recourse to use the centre 15 and to evaluate the impact of this in terms rate of patients eligible for thrombolysis. Note: SAMU=emergency medical service; SMUR=mobile intensive care unit Objectifs, contexte L9Accident Vasculaire Cerebral (AVC) est une urgence necessitant une prise en charge precoce et rapide du patient dans une filiere de soins adaptee. Devant une suspicion d9AVC, l9appel au SAMU-Centre 15 en premiere intention est recommande. L9objectif de ce travail est de decrire les filieres d9urgence de prise en charge des suspicions d9AVC et d9evaluer l9impact de l9appel au 15. Programme Un registre de pratiques a ete mis en place en avril 2008 par l9Observatoire Regional des Urgences de Midi-Pyrenees aupres de toutes les structures d9urgence publiques de la Haute-Garonne. Tous les patients de 18 ans et plus presentant une suspicion d9AVC ou AIT recent ont ete inclus par le centre de reception et de regulation des appels du SAMU31, les SMUR et les services d9urgence. La presente evaluation porte sur les patients pris en charge par le Centre Hospitalier de Saint-Gaudens (SMUR et service d9urgence) sur une periode de 15 mois. Cet etablissement dessert un bassin de population de 75 000 habitants. Il est situe au sud du departement, a 1h du CHU de Toulouse (siege de l9unite neuro-vasculaire de reference et du SAMU). Sur place, il dispose d9un scanner mais pas d9un neurologue. Resultats 226 patients ont ete inclus entre le 1er avril 2008 et le 30 juin 2009 dont la moyenne d9âge est de 79 ans [32-97] et le sex-ratio de 0,45. Le taux d9exhaustivite est de 100 %. 58% des patients ont ete regules par le SAMU31, soit par appel direct au 15 (79%), soit apres contact avec un medecin liberal (21%). Parmi ces patients regules, 9,3% ont ete pris en charge par le SMUR de Saint-Gaudens. Parmi les patients arrivant directement aux urgences, sans regulation prealable (42%), 56% ont contacte un medecin liberal en 1ere intention. Le delai median entre le debut des symptomes et l9arrivee aux urgences est pour l9ensemble des patients de 151 min (86-352). Il est plus court pour les patients regules (146 min vs 155 min; p=0,67). La duree mediane de presence aux urgences, globalement de 210 minutes, est plus courte pour les patients regules (190 min vs 239 min, p=0,06). Le delai median entre l9arrivee aux urgences et l9examen clinique est significativement plus court pour les patients regules (11 min vs 26 min, p Developpement, perspectives, limites Le registre permet d9objectiver et de comparer les prises en charge. Nos resultats confirment l9impact clinique de la prise en charge apres appel au 15: delai de prise en charge aux urgences plus court, permettant une prise en charge plus precoce. Le gain de temps estime a 15 minutes, peut permettre d9augmenter le taux de patients eligibles thrombolyses. Cependant, seuls 58 % des patients empruntent cette filiere. Ce recueil permettra d9evaluer l9impact (1) de la mise en place des campagnes d9information sur le taux d9appel au 15 en 1ere intention (2) sur le pronostic final (score de Rankin).a 3 mois de suivi. Conclusion Les resultats du registre temoignent d9un gain de temps dans la prise en charge en urgence de l9AVC quand le SAMU-Centre 15 est appele. Notre axe immediat d9amelioration est de renforcer l9information des usagers et des medecins generalistes pour augmenter le recours au SAMU – Centre 15 et d9en evaluer l9impact en terme de patients eligibles thrombolyses.