To investigate the accuracy of stroke versus stroke mimics diagnoses made while evaluating patients via Telestroke (TS).

TS networks have become standard in many areas of the US, increasing thrombolysis rates in patients with acute ischemic stroke (AIS). By providing an early, accurate diagnosis, patients with stroke mimics may also benefit from TS consultation and avoid unnecessary treatments and transfers. However, despite TS systems having up to 50% mimic rates, it is unknown if TS can accurately diagnose patients with stroke versus stroke mimics.

This was a retrospective review of consecutive TS consults at the University of Utah Hospital to 27 TS sites in six states from January to December 2018. Clinical information and diagnosis were extracted from discharge records and compared to those from the TS consult. Discharge diagnoses were determined by the discharging physician and coded into 12 categories by two physicians. Cases without a clear discharge diagnosis were excluded.

We reviewed 476 TS cases (mean age 66 years; 54% women); 71 were excluded for lack of discharge diagnosis leaving 405 cases for analysis. Of these, 225 were diagnosed with AIS/TIA; 102 (45%) received IV tPA. Our study demonstrated high diagnostic agreement for AIS/TIA (88%) with a kappa of 0.75 for stroke and mimics. Of the 180 patients diagnosed with a stroke mimic on TS, 27 (15%) were diagnosed with AIS/TA by discharge. TS mimic diagnosis had a PPV of 85% and NPV of 90%; TS diagnosis of stroke/TIA had PPV90%, NPV 85%.

The Utah TS system has excellent correlation between TS and discharge diagnoses for patients with both stroke and stroke mimics suggesting that TS systems can accurately assess a wider variety of patients with acute neurological syndromes other than AIS.