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Does Acute Ischemic Stroke Require Repeat CT at 24-hours?
Stroke Care is Changing
Recent developments in scientific research surrounding stroke clients provide an alternative to the usual care. Medical care must reflect contemporary research to identify the care plan for the best possible outcome. Appropriate and safe medical care is guided by using quality evidence-based research, and this situation is no different!
The Study: Routine Neuroimaging After Stroke
A patient with an ischemic stroke is given a drug through their IV called tissue plasminogen activator (tPA) that destroys the clot that cause the blockage. Routine computed tomography (CT) imaging traditionally occurs 24 hours later to evaluate the bleeding.
Recently, the necessity of repeat 24-hour imaging in stroke patients has been called into question. Routine repeat imaging in patients seldom changes the plan of care for those who are stable. Thus, the CT scan performed at 24-hours after the stroke may not be necessary.
The benefits of routine CT scan in ischemic stroke patients who received tPA was examined.1 The results showed that stroke patients whose National Institute of Health Stroke Scale (NIHSS) score has a baseline of less than ten and remains stable are unlikely to have any effects by routine imaging.
The purpose of the repeat CT scan is to evaluate stroke patients for overall risk of cerebral hemorrhage. No patient with an NIHSS score of less than ten experienced a brain hematoma on the routine repeat imaging without first becoming unstable.1
This study of post-acute ischemic stroke patients who received tPA determined that routine repeat neuroimaging is not necessary for clinically stable patients. This will decrease excessive radiation exposure and minimize medical costs.
This study analyzed patients who were admitted to Tulane Medical Center and seen by the Neurology Department between 2008 and 2011. In order to be included in the study, patients had to have a documented 24-hour NIHSS score and tPA therapy.1 The repeat CT scans were reviewed by a specialist.
Patients were divided into two groups:
- those whose 24-hour NIHSS score remained the same from baseline
- those that worsened after admission.
Strengths & Weaknesses
The strengths of this study promote nursing autonomy, minimize client exposure to radiation, and decrease medical costs.
- Nursing staff is able to identify clinically unstable stroke patients at the risk of a cerebral hemorrhage.
- By minimizing the exposure of the client to radiation, the medical staff is encouraging optimal health.
- Finally, eliminating redundant and expensive imaging studies significantly decreases a client’s medical expenses.
The weakness of this study is that it did not directly study nursing staff and their reflection this new data.
A client with an acute ischemic stroke diagnosis who had been given tPA has several options regarding neuroimaging. Currently, data shows that routine and repeat 24-hour CT imaging to evaluate for a brain hemorrhage may not be needed as long as nurses are vigilant over their clients. In the case of a client becoming clinically unstable or their NIHSS score worsens, it is imperative that the nurse reports the situation to the appropriate provider.
George, A. J., Boehme, A. K., Dunn, C. R., Beasley, T., Siegler, J. E., Albright, K. C…Martin-Schild, S. (2015). Trimming the fat in acute ischemic stroke: An assessment of 24-h CT scans in tPA patients. International Journal of Stroke, 10(1), 37-41. doi: 10.1111/ijs.12293.
© 2018 Caitlin Goodwin