The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network.

Autor: Ali SF; Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.)., Viswanathan A; Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.)., Singhal AB; Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.)., Rost NS; Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.)., Forducey PG; INTEGRIS Health, Oklahoma City, OK (P.G.F., L.W.D.)., Davis LW; INTEGRIS Health, Oklahoma City, OK (P.G.F., L.W.D.)., Schindler J; Yale-New Haven Stroke Center, New Haven, CT (J.S.)., Likosky W; Swedish Medical Center, Seattle, WA (W.L., S.S.)., Schlegel S; Swedish Medical Center, Seattle, WA (W.L., S.S.)., Solenski N; University of Virginia, Charlottesville, VA (N.S.)., Schwamm LH; Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2014 Jun 23; Vol. 3 (3), pp. e000838. Date of Electronic Publication: 2014 Jun 23.
DOI: 10.1161/JAHA.114.000838
Abstrakt: Background: Up to 30% of acute stroke evaluations are deemed stroke mimics (SM). As telestroke consultation expands across the world, increasing numbers of SM patients are likely being evaluated via Telestroke. We developed a model to prospectively identify ischemic SMs during Telestroke evaluation.
Methods and Results: We analyzed 829 consecutive patients from January 2004 to April 2013 in our internal New England-based Partners TeleStroke Network for a derivation cohort, and 332 cases for internal validation. External validation was performed on 226 cases from January 2008 to August 2012 in the Partners National TeleStroke Network. A predictive score was developed using stepwise logistic regression, and its performance was assessed using receiver-operating characteristic (ROC) curve analysis. There were 23% SM in the derivation, 24% in the internal, and 22% in external validation cohorts based on final clinical diagnosis. Compared to those with ischemic cerebrovascular disease (iCVD), SM had lower mean age, fewer vascular risk factors, more frequent prior seizure, and a different profile of presenting symptoms. The TeleStroke Mimic Score (TM-Score) was based on factors independently associated with SM status including age, medical history (atrial fibrillation, hypertension, seizures), facial weakness, and National Institutes of Health Stroke Scale >14. The TM-Score performed well on ROC curve analysis (derivation cohort AUC=0.75, internal validation AUC=0.71, external validation AUC=0.77).
Conclusions: SMs differ substantially from their iCVD counterparts in their vascular risk profiles and other characteristics. Decision-support tools based on predictive models, such as our TM Score, may help clinicians consider alternate diagnosis and potentially detect SMs during complex, time-critical telestroke evaluations.
(© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
Databáze: MEDLINE
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