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Audit: CT Scanning and Reporting in Thrombolysis Patients
EP30588
Poster Title: Audit: CT Scanning and Reporting in Thrombolysis Patients
Submitted on 14 Sep 2019
Author(s): Rowan Ah-See, Alex Reid, John Reid
Affiliations: Aberdeen Royal Infirmary, NHS Grampian
This poster was presented at BIR 2019
Poster Views: 347
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Poster Information
Abstract: CT Scanning and Reporting in Thrombolysis Patients

Background:
Thrombolytic therapy with alteplase is currently the only effective and approved pharmacological treatment for acute ischaemic stroke in the UK (1). CT scanning is required before treatment to rule out haemorrhagic stroke. This audit aims to determine whether NICE guidance is being followed in patients who undergo thrombolysis. We additionally evaluated the time from CT scan to report in relation to thrombolysis and assessed the content of CT scan requests and reports.

Standard:
NICE guidance on alteplase treatment for ischaemic stroke (2)

Indicator:
Percentage of patients who receive thrombolysis in whom intracranial haemorrhage is excluded on CT

Target:
Aim 100% compliance

Methodology:
66 cases of patients who were thrombolysed from January to June 2018 were included. Information was gathered from CT requests and reports.

Results of 1st audit round:
In 65/66 (98.5%) intracranial haemorrhage was excluded on CT prior to thrombolysis. In 1 case the scan reported a haemorrhage but the patient went on to receive thrombolysis. In this instance, the provisional verbal report delivered to the stroke team differed from the final approved report. Analysis of timings found that the written CT report was often available within the time taken to administer thrombolysis. CT requests frequently failed to mention consideration for thrombolysis or contraindications.

Action plan
Present data at local inter-departmental meeting. Implement educational measures to improve request form content. Aim to improve communication of contraindications on CT to stroke physicians even if thrombolysis has already begun.
Summary: Thrombolysis is a time-pressured treatment for ischaemic stroke which relies on rapid CT scanning to exclude intracerebral haemorrhage. This audit explores the relationship between the timing of thrombolysis administration and CT scan reporting highlighting aspects of clinical and radiological practice including poor request form content, the delivery of provisional reports and the communication of contraindications on CT. References: References:
1. Frank B, Grotta JC, Alexandrov AV et al. Thrombolysis in Stroke Despite Contraindications or Warnings? Stroke. 2013; 44: 727-733
2. National Institute for Health and Care Excellence. Alteplase for treating acute ischaemic stroke (Technology Appraisal Guidance TA264). 2012. Available at: https://www.nice.org.uk/guidance/ta264
3. Stroke Association. What Is Stroke: Treatment. No date. Available at: https://www.stroke.org.uk/what-is-stroke/diagnosis-to-discharge/treatment
4. Image from CT scan showing intracranial haemorrhage used with no patient identifiable data present.
5. Other images used courtesy of Wikimedia Commons.
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