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Background and Purpose— The aim of this study is to determine agreement among vascular neurology fellows and faculty in treating patients with acute ischemic stroke with intravenous tissue-type plasminogen activator and intra-arterial thrombectomy (IAT). Methods— Patients were evaluated simultaneously by at least 2 vascular neurology. Agreement was determined using kappa (κ) and intraclass correlation coefficients. Results— In 60 patients, agreement was substantial for tissue-type plasminogen activator (κ=0.75 [95% confidence interval, 0.57–0.92]) and IAT (κ=0.63 [95% confidence interval, 0.30–0.96]), with no difference between fellow–fellow versus fellow–faculty. Intraclass correlation coefficient for National Institutes of Health Stroke Scale was 0.94 (95% confidence interval, 0.90–0.97) and κ for Alberta Stroke Program Early CT Score was 0.53 (95% confidence interval, 0.20–0.78). Rapidly improving or mild deficits caused disagreement for both tissue-type plasminogen activator and IAT, whereas interpretation of computed tomographic perfusion led to disagreement for IAT. Conclusions— We found substantial agreement between vascular neurology fellows and faculty in treating with tissue-type plasminogen activator or IAT. Areas for improvement include recognition of stroke mimics, consensus on treating less severe strokes, and use/interpretation of imaging.

Background and purpose Interventions are needed to improve stroke literacy among recent stroke survivors. We developed an educational video for patients hospitalized with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Methods A 5-minute stroke education video was shown to our AIS and ICH patients admitted from March to June 2015. Demographics and a 5-minute protocol Montreal Cognitive Assessment were also collected. Questions related to stroke knowledge, self-efficacy, and patient satisfaction were answered before, immediately after, and 30 days after the video. Results Among 250 screened, 102 patients consented, and 93 completed the video intervention. There was a significant difference between pre-video median knowledge score of 6 (IQR 4–7) and the post-video score of 7 (IQR 6–8; p

Introduction: Depression screening may not be feasible for all stroke patients during their hospitalization, and depression may be missed if screening is not performed in the outpatient setting. Hypothesis: We sought to assess the proportion of patients with depression, and describe the severity of depressive symptoms in patients who could not be screened during hospitalization. We hypothesized that depressive symptoms can be missed in those who are not screened. Methods: Ischemic strokes (July 2014- July 2015) were identified from the clinic registry. In the clinic, we use Patient Health Questionnaire 9 (PHQ-9) to assess depressive symptoms for all patients. Univariate and multivariable linear regression analyses were used to evaluate associations between PHQ-9 and age, sex, race, baseline National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and antidepressant use for patients who missed inpatient depression screening. Results: Among 159 ischemic stroke patients, 136 completed outpatient PHQ-9 within 90 days from stroke onset. Of these 41 (30%) were missing inpatient PHQ-9. Reasons for missing scores included aphasia or cognitive impairment (20), failed inpatient attempt (16), or unspecified reasons (5). Among the 41 patients, median time to follow-up was 40 days (IQR 33 - 50). Mean (SD) age was 63.7 (13.8) and 51.2% were female. Mean (SD) PHQ-9 score was 8.0 (6.61). The overall proportion of patients having at least mild depression was 60.1% (95 % CI 45.3, 76.5) and PHQ-9 scores were distributed as follows: none to minimal depressive symptoms, 39.0%; mild to moderate, 43.9%, moderately severe to severe, 17.1%. In the regression model, mRS at follow-up (dichotomized < 3 & ≥ 3) was associated with severity of depressive symptoms after adjusting for age, sex, and baseline NIHSS, (coefficient 4.1, 95% CI 1.38, 6.82). Other variables were not associated with severity of depressive symptoms. Conclusions: Patients who cannot be screened for depression during hospitalization may have depressive symptoms and should be screened as soon as feasible after discharge. Alternative methods to screen cognitively impaired patients need to be developed.