Abstract NS4: Dizziness In Stroke: Triage Nurses Identify Posterior Circulation Strokes In A Comprehensive Stroke Center Emergency Department Using Three Simple Questions

Introduction: Recognition of stroke alerts in triage are imperative to the rapid evaluation of acute ischemic stroke. Patients who present to the Emergency Department (ED) with a chief complaint of dizziness have historically been challenging for triage nurses. Missed triage opportunities may result in increased door to needle (DTN) times. The goal of this study was to assess if a dizziness triage tool can reduce missed posterior circulation strokes and decrease DTN times. Methods: We developed the following three questions: Is the room spinning, shaking, or are you lightheaded; does it come and go or is it persistent with sudden onset within the last six hours; does the dizziness change with position. If the description of dizziness was sudden, spinning/shaking, persistent, and non-positional, then the patient was triaged as a stroke. ED RNs were trained and education tools were distributed in January 2019. Data were retrospectively reviewed on patients who presented with dizziness, were diagnosed with posterior circulation strokes, and received IV Alteplase. Dizziness for this study was defined as: dizziness, dizzy, vertigo, lightheaded, room spinning, room shaking, unsteadiness, and/or imbalance. Data were reviewed pre and post implementation over a three-year period to assess the percentage of patients captured by the tool and its impact on DTN times. Data were analyzed using a t-test. Results: Patients with a Brain Alert were older (71 {IQR 59-74}) vs. No Brain Alert (57 {IQR 53-63} p=0.036) yrs. 86% of women had no brain alert whereas 62% of men did. The median NIHSS for Brain Alert was 3 (IQR 1-4) vs. no brain was 1 (IQR 1-4) (p=0.89). In the pre-implementation time frame 47% (7/15) of dizzy patients diagnosed with ischemic stroke and received alteplase were captured by a triage nurse activated brain alert. Post implementation 89% (8/9) and 100% (4/4) were captured in 2019 and 2020 respectively. Median DTN for dizzy patients improved from 56 mins in 2018 (IQR 44-92) to 46 mins in 2020 (IQR 36-60) p=0.025. Conclusion: A triage nurse three-question dizziness tool is successful and sustainable in identifying posterior circulation strokes in the emergency department which helps to decrease DTN times in these patients.