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Lerario MP, Kummer BR, Wu X, Diáz I, Pishanidar S, Willey JZ, Mir S, Cheng N, Rostanski SK, Efraim ES, Crupi RS, Schenker J, Asaeda G, Bokser J, Kamel H, Marshall RS, Navi BB, Fink ME. Abstract WP104: Clinical Characteristics of Stroke Mimics Treated on an Urban Mobile Stroke Unit. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
It is unknown how the clinical characteristics of stroke mimics treated on Mobile Stroke Units (MSUs) compare to confirmed acute strokes treated on these units.
Methods:
We retrospectively analyzed all patients transported by the NewYork-Presbyterian MSU in New York City from October 2016-May 2018. A vascular neurologist assigned a final diagnosis after comprehensive medical record review. Clinical data were abstracted, including comorbidities, presenting symptoms, stroke severity, acute treatments, and short-term outcomes. We compared characteristics of patients with a stroke mimic diagnosis versus those with acute ischemic or hemorrhagic stroke using targeted minimum loss-based estimation to adjust for demographics, comorbidities, NIH Stroke Scale (NIHSS) score, and intravenous tPA administration.
Results:
Among 92 suspected stroke patients transported by MSU, 56 (61%) had confirmed acute stroke (77% ischemic, 23% hemorrhagic) and 36 (39%) had a stroke mimic. Mimics consisted of seizure (n=8), metabolic encephalopathy (n=6), somatoform disorders (n=4), and others (n=18). The mean NIHSS score was 8 (SD 7) among mimics versus 11 (SD 8) among confirmed strokes (p=0.14). The top presenting symptoms among mimics were unilateral weakness (n=8), aphasia (n=6), confusion (n=6), and decreased consciousness (n=6). Nine mimics (25%) received tPA and none had hemorrhagic conversion; while 30 (53%) confirmed strokes received tPA and 2 (7%) had hemorrhagic conversion. There was no difference in MSU arrival-to-tPA time between groups (46 vs. 44 minutes, p=0.70). In multivariable analyses, compared to patients with confirmed stroke, mimics had significantly lower NIHSS scores, higher initial blood pressures, and shorter lengths-of-stay. Rates of death and discharge disposition were similar between groups.
Conclusions:
Among patients transported by a MSU for suspected stroke, two-fifths were stroke mimics. Seizure, metabolic encephalopathy, and somatoform disorders were the most common mimic diagnoses. Patients with stroke mimics had lower NIHSS scores and less often were treated with tPA.
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Affiliation(s)
- Michael P Lerario
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Queens, New York, NY
| | - Benjamin R Kummer
- Dept of Neurology, Columbia Univ Med Cntr; Dept of Neurology, Icahn Sch of Medicine at Mount Sinai, New York, NY
| | - Xian Wu
- Dept of Healthcare Policy and Rsch, Div of Biostatistics and Epidemiology, Weill Cornell Med College, New York, NY
| | - Iván Diáz
- Dept of Healthcare Policy and Rsch, Div of Biostatistics and Epidemiology, Weill Cornell Med College, New York, NY
| | - Sammy Pishanidar
- Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Queens, New York, NY
| | | | - Saad Mir
- Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Natalie Cheng
- Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Brooklyn Methodist Hosp, New York, NY
| | | | | | - Robert S Crupi
- Dept of Medicine, NewYork-Presbyterian Queens, Flushing, NY
| | - Josef Schenker
- Dept of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hosp, Brooklyn, NY
| | - Glenn Asaeda
- Office of Med Affairs, Fire Dept of New York, New York, NY
| | - Jeffrey Bokser
- Dept of Emergency Med Services, NewYork-Presbyterian Hosp, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | | | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Matthew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
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Lerario MP, Gupta A, Kummer BR, Diáz I, Lin E, Lantos JE, Knight-Greenfield A, Nario JJ, Efraim ES, Asaeda G, Bokser J, Navi BB, Kamel H, Fink ME. Abstract WP92: Radiologist Inter-rater Reliability of Prehospital Alberta Stroke Program Early CT Scores on a Mobile Stroke Unit. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The computed tomography (CT) capabilities of mobile stroke units (MSUs) may facilitate prehospital triaging of patients with suspected large-vessel occlusion directly to thrombectomy-capable centers. However, little is known about the reliability of radiological interpretation of early ischemic changes on prehospital CTs.
Methods:
We identified all patients transported by the NewYork-Presbyterian MSU to Weill Cornell Medical Center with the diagnosis of acute ischemic stroke, transient ischemic attack, or stroke mimic between October 3, 2016 and December 31, 2017. All patients underwent noncontrast head CT on board the MSU using a CereTom® scanner. As controls, we matched these patients 1:1 by diagnosis to patients who were transported by standard ambulance and underwent noncontrast brain CT in our emergency department (ED) over the same period. Two neuroradiologists, blinded to patients’ characteristics and final diagnosis, independently calculated Alberta Stroke Program Early CT Scores (ASPECTS) on all scans. Weighted percent agreement and Cohen’s κ were used to assess inter-rater reliability, and paired t-tests were used to compare these metrics between MSU and ED scans.
Results:
Among 46 MSU patients and 46 ED patients, 52% had a diagnosis of acute ischemic stroke, 46% a diagnosis of stroke mimic, and 2% a diagnosis of transient ischemic attack. For ASPECTS score as a continuous outcome, the weighted inter-rater agreement was 98% for MSU scans versus 96% for ED scans (mean difference, 2%; 95% CI, -1% to 5%) and the weighted κ was 0.49 for MSU scans versus 0.54 for ED scans (mean difference, -0.05; 95% CI, -0.61 to 0.51). For ASPECTS score categorized as 0-4, 5-7, or 8-10, the weighted inter-rater agreement was 99% for MSU scans versus 97% for ED scans (mean difference, 2%; 95% CI, -2% to 7%) and the weighted κ was 0.66 for MSU scans versus 0.55 for ED scans (mean difference, 0.10; 95% CI, -0.87 to 1.08).
Conclusions:
In a sample of 96 patients, which limited our power to detect small differences, we found no substantial difference in the inter-rater reliability of ASPECTS scores obtained from MSU CTs versus ED CTs.
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Affiliation(s)
- Michael P Lerario
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College; Dept of Neurology, NewYork-Presbyterian Queens, New York, NY
| | - Ajay Gupta
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Radiology, Weill Cornell Med College, New York, NY
| | - Benjamin R Kummer
- Dept of Neurology, Columbia Univ Med Cntr; Dept of Neurology, Icahn Sch of Medicine at Mount Sinai, New York, NY
| | - Iván Diáz
- Div of Biostatistics and Epidemiology, Dept of Healthcare Policy and Rsch, Weill Cornell Med College, New York, NY
| | - Eaton Lin
- Dept of Radiology, Weill Cornell Med College, New York, NY
| | | | | | - Joel J Nario
- Dept of Radiology, Weill Cornell Med College, New York, NY
| | | | - Glenn Asaeda
- Office of Med Affairs, Fire Dept of New York, New York, NY
| | - Jeffrey Bokser
- Dept of Emergency Med Services, NewYork-Presbyterian Hosp, New York, NY
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
| | - Matthew E Fink
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Rsch Institute and Dept of Neurology, Weill Cornell Med College, New York, NY
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