Abstract Details

Title Predictive Value of Signs and Symptoms in Code Strokes for Diagnosis of Ischemic Stroke or Transient Ischemic Attack

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 061

Objective

This study aimed to determine the history features, signs and symptoms identified during a code stroke that correlate with the diagnosis of ischemic stroke or transient ischemic attack (TIA). We also aimed to determine the rate of stroke mimics and investigate the development of a clinical prediction model.

Background Diagnosis of acute ischemic stroke is challenging, but rapid treatment improves outcomes. Weakness involving the face, arm or leg is commonly associated with stroke but cortical signs are less frequently reported. The predictive value of sensory change, headache, dizziness or vertigo are debated.

Design/Methods Consecutive code stroke presentations to a primary stroke center were recruited. Patient characteristics, medical history and signs or symptoms that led to activation of code stroke were collected from the medical record. Diagnosis of ischemic stroke was determined by radiographic evidence of infarction. Univariate analysis and multivariable logistic regression analysis were used to determine the features that predict ischemic stroke/TIA versus mimic.

Results There were 493 code strokes analysed. 64.5% were stroke mimics. The most commonly diagnosed mimics were migraine, peripheral vertigo and seizure. Upper limb sensory change (OR 3.27 [95% CI, 1.75-6.11]), hemiplegia (OR 2.70 [95% CI, 1.65-4.43]), dysphasia (OR 2.62 [95% CI, 1.56-4.40]) and history of atrial fibrillation (OR 2.01 [95% CI, 1.14-3.54]) or hypertension (OR 1.77 [95% CI, 1.10-2.83]) are highly predictive of stroke/TIA. Headache (OR 0.40 [95% CI, 0.23-0.69]) is predictive of a mimic. Dizziness and vertigo were more common in stroke mimics. The C-statistic for the study models ranged from 0.70 to 0.76

Conclusions Objective signs such as unilateral motor weakness and dysphasia are highly predictive of ischemic stroke/TIA whereas symptoms of headache and dizziness are suggestive of stroke mimic. Stroke mimic rate is influenced by local prevalence and threshold for code stroke activation. Incorporating positive and negative predictive features may improve future stroke prediction tools.

Authors/Disclosures
Mei Y. Ngun, MBBS (Northern Health, Neurology Department) PRESENTER	Dr. Ngun has nothing to disclose.
	No disclosure on file
Douglas E. Crompton, MBBS, PhD (Northern Health)	Dr. Crompton has nothing to disclose.

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Abstract Details