Details

Autor(en) / Beteiligte

• Navalkele, Digvijaya
• Vahidy, Farhaan S
• Emily, Nichols
• Nisar, Tariq
• Salmeron, William
• Hargrove, Paige
• Salerian, Justin A
• Vidal, Gabriel
• Jennings, Bethany
• Samai, Alyana
• Franco, Lia
• Martin-Schild, Sheryl

Titel

Abstract P173: Stroke Mimics in Patients With Discordance Between VAN Determination by EMS and Experienced Stroke Teams

Ist Teil von

• Stroke (1970), 2021-03, Vol.52 (Suppl_1)

Erscheinungsjahr

2021

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Abstract only Background: Discordance between pre-hospital (EMS) and experienced stroke team (ED) determination of Vision-Aphasia-Neglect (VAN) assessment threatens VAN’s utility in routing patients with large vessel occlusion (LVO) to thrombectomy centers. Discordance may be due to a fluctuating exam in the setting of stroke or stroke mimics. We sought to evaluate the rate and etiology of stroke mimics in patients with discordant versus concordant VAN assessments. Methods: The EMS run reports were linked with stroke registries from three CSCs in New Orleans, Louisiana from 2/2019-7/2019. EMS-VAN was compared to that of CSCs in all patients who presented within 6 hours of last seen normal. Stroke mimics were compared in patients with concordance vs discordance between VAN determination by EMS and experienced stroke teams. Results: EMS documented VAN in 63.2% of stroke codes brought to CSCs. Concordance was 66.9%; the k, CI was 0.35, 0.20 - 0.50. The proportion of stroke mimics was largest in concordant VAN negative patients (64.4%) with seizures and altered mental status (23.7% each) the most frequent causes. The proportion of stroke mimics was smallest in concordant VAN positive patients (17.3%) with seizures as the most frequent cause (44.4%). Similar high frequency of seizure mimic was determined in VAN discordant patients; seizure accounted for 47.8% of discordant mimics and 20% of all discordant patients. Discussion: VAN assessment as performed by trained EMS providers had only fair correlation with experienced stroke team members. The rapidly evolving exam of patients with seizures may explain a significant portion of stroke mimics among patients whose exams change between EMS and ED stroke team assessments.