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Abstract Details

Optimizing the Evaluation and Treatment of In-Hospital Stroke
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
113
We assessed the "2CAN" score (Chang, Stroke 2018) in our own patient population as a tool for identifying inpatient stroke.
Stroke-like symptoms may be difficult to appreciate due to the high incidence of stroke mimics (e.g. delirium) in the inpatient population (Cumbler, J Hosp Med 2015). Many centers have adopted inpatient-specific stroke protocols with the aim of improving time to diagnosis and treatment (Kassardjian, Stroke 2017).
A retrospective chart review was conducted for all inpatients for whom our Brain Attack Team (BAT) was called between January 2015 and June 2019. Patients were excluded if they had stroke prior to current admission, were in the ED at time of BAT call, or had incomplete documentation. The 2CAN score was calculated for each patient.
The BAT was activated 201 times, with 110 patients meeting inclusion criteria. Mean age was 61 (SD 14) and 46% were female. Twenty percent of patients had a history of A-fib, 72% HTN, and 36% DM. Median NIHSS was 15 (IQR 5-24). Only 10% of stroke calls occurred within 24 hours of hospital admission. 2CAN scores ranged from 0 to 5, with a mean of 2.8 (SD 1.2). Ninety-seven (88%) of patients received a final diagnosis of ischemic stroke and 13 (12%) of stroke mimic. There was no difference between 2CAN scores for the stroke and mimic groups (P = 0.91). A 2CAN score of ≥2 had sensitivity 83.5%, specificity 23.1%, PPV 89.0%, and NPV 15.8% for stroke in our cohort. A score of ≥3 had sensitivity 62.9%, specificity 30.8%, PPV 87.1%, and NPV 10.0%.
The 2CAN score was derived and validated in a single academic center as a tool for the non-neurology provider to recognize stroke. The 2CAN score had good sensitivity and positive predictive value for stroke in our cohort, but poor specificity.
Authors/Disclosures
Christopher Parrino
PRESENTER 		Mr. Parrino has nothing to disclose.
Aaron P. Noles, MD Dr. Noles has nothing to disclose.
Rakhee Lalla, DO Dr. Lalla has received personal compensation in the range of $0-$499 for serving as a Consultant for Women's health initiative .
Prachi Mehndiratta, MD Dr. Mehndiratta has nothing to disclose.
Michael Phipps, MD, MHS, FÂ鶹´«Ã½Ó³»­ (University of Maryland School of Medicine) Dr. Phipps has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMJ.
Carolyn Cronin, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Vanderbilt University Medical Center) Dr. Cronin has nothing to disclose.
John Cole, MD (UMD SOM) Dr. Cole has nothing to disclose.
Marcella A. Wozniak, MD, PhD (U of MD Department of Neurology) Dr. Wozniak has nothing to disclose.
Karen L. Yarbrough No disclosure on file
Seemant Chaturvedi, MD, FAHA, FÂ鶹´«Ã½Ó³»­ (University of Maryland) Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Chaturvedi has received research support from NINDS.