title: Pattern of informed consent acquisition in patients undergoing emergent endovascular treatment for acute ischemic stroke.
abstract: BACKGROUND
  Telephone consent and two physician consents based on medical necessity are alternate strategies for time sensitive medical decisions but are not uniformly accepted for clinical practice or recruitment into clinical trials. We determined the rate of and associated outcomes with alternate consenting strategies in consecutive acute ischemic stroke patients receiving emergent endovascular treatment.
  
  
  METHODS
  We divided patients into those treated based on in-person consent and those based on alternate strategies. We identified clinical and procedural differences and differences in hospital outcomes: symptomatic ICH and favorable outcome (defined by modified Rankin Scale of 0-2 at discharge) based on consenting methodology.
  
  
  RESULTS
  Of a total of 159 patients treated, 119 were treated based on in-person consent (by the patient in 27 and legally authorized representative in 92 procedures). Another 40 patients were treated using alternate strategies (20 telephone consents and 20 two physician consents based on medical necessity). There was no difference in the mean ages and proportion of men among the two groups based on consenting methodology. There was a significantly greater time interval incurred between CT scan and initiation of endovascular procedure in those in whom in-person consent was obtained (117 ± 65 min versus 101 ± 45 min, p = 0.01). There was no significant difference in rates of ICH (9% versus 8%, p = 0.9), or favorable outcome at discharge (28% versus 30%, p = 0.8).
  
  
  CONCLUSIONS
  Consent through alternate strategies does not adversely affect procedural characteristics or outcome of patients and may be more time efficient than in-person consenting process.
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Sarwat
authors.initials: S
authors.lastname: Gilani
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Shahram
authors.initials: S
authors.lastname: Majidi
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Ameer E
authors.initials: AE
authors.lastname: Hassan
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Jefferson T
authors.initials: JT
authors.lastname: Miley
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA;
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodriguez
keywords: Informed consent; endovascular treatment; ischemic stroke; procedure time; thrombolytics