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Professor Erkki Isomets, M.D., Ph.D. Department of Psychiatry, University of Helsinki, Finland Department of Mental Health and Alcohol Research, National Public Health Insitute, Helsinki, Finland and Docent Kirsi Suominen, M.D., Ph.D. Department of Psychiatry, Jorvi Hospital, University of Helsinki, Finland Department of Mental Health and Alcohol Research, National Public Health Insitute, Helsinki, Finland.

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Approximately 1.7 million people or 20% of the NSW population ; will attend an emergency department in NSW each year. The proportion of urgent emergency department attendance seen by a doctor within waiting time benchmarks is currently reported in monthly Finance and Performance Report. This provides an indication of the ability of the community to gain reasonable access and attention at hospital facilities. This KPI is critical as time spent waiting in queues is a frequent source of customer frustration across all industries. All people who seek attention at an emergency department are triaged using a scale developed by the Australian College for Emergency Medicine. Triaging is the process of sorting patients according to the urgency of treatment required. The national triage scale and a snapshot of NSW performance is presented below. Zurab Nadareishvili, Stroke Branch, NINDS NIH, Bethesda, MD; Hong Li, Violet Wright, Stroke Neuroscience Unit, NINDS NIH, Bethesda, MD; Dragan Maric, Jeffery L Barker, Laboratory of Neurophysiology, NINDS NIH, Bethesda, MD; John M Hallenbeck, Stroke Branch, NINDS NIH, Bethesda, MD; James Dambrosia, Biostatistics Branch, NINDS NIH, Bethesda, MD; Alison E Baird; Stroke Neuroscience Unit, NINDS NIH, Bethesda, MD Background and Purpose: Inflammation is a risk factor for heart disease and stroke. CD4 CD28cells occur in 5% of CD4 T cells, but levels can increase markedly in unstable angina when endothelial cells are susceptible to cytotoxicity by CD4 CD28- cells. Our purpose was to determine whether elevated CD4 CD28- cell counts are associated with recurrent stroke and or death in patients with acute ischemic stroke. Methods: Consecutive patients within the first 48 hours of ischemic stroke were prospectively studied. Peripheral blood CD4 CD28- cells were quantified by flow cytometry. The primary endpoint was recurrent stroke and or death from any cause. Results: One hundred and six patients mean age 75.0 13.5 years, 50 females ; were studied. The median CD4 CD28- count was 4.1% range 0.272.2% ; . Thirty primary endpoints 10 recurrent strokes and 20 deaths ; occurred during follow-up that ranged from 5 to 590 days, with a median follow-up of 174 days. Comparison of Kaplan-Meier survival curves showed that the hazard of recurrent stroke death was significantly higher in patients with high 5% ; CD4 CD28- cell counts compared to those with a lower 5% ; percentage of these cells log rank 5.73, p 0.01 ; . In a multivariate Cox proportional hazards analysis, older age p 0.006 ; , higher admission NIHSS score p 0.007 ; , and higher CD4 CD28- cell count p 0.03 ; were significant hazards for recurrent stroke death. In addition, a higher median percentage of CD4 CD28- cells was found in patients with a prior history of stroke n 33 ; than those without 9.3 vs. 2.9, p 0.001 ; . As prior stroke was strongly correlated with stroke recurrence and death p 0.01 ; , CD4 CD28- cells were not an independent hazard for this outcome after adjustment for prior stroke p 0.09 ; . Conclusion: Increased counts of circulating CD4 CD28- cells are associated with recurrent stroke and death in patients with acute ischemic stroke. The association of this cell type with prior stroke suggests that these cells may be a stroke risk factor and or a consequence of prior stroke. CD4 CD28-cells may represent a biomarker involved in the pathophysiology of stroke recurrence and may qualify as a surrogate endpoint and therapeutic target for stroke prevention trials.

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