External Validation of Stroke Mimic Prediction Scales in the Emergency Department
| Autor: | Guan Zhong Tan, Chee Keong Wee, Camlyn Tan, David Jeremiah Ming Siang Chee, Tian Ming Tu, Hoon Chin Lim, Seyed Ehsan Saffari |
|---|---|
| Přispěvatelé: | Lee Kong Chian School of Medicine (LKCMedicine) |
| Rok vydání: | 2020 |
| Předmět: |
Stroke/etiology
Adult Male medicine.medical_specialty Clinical Decision-making Neurology medicine.medical_treatment Tissue plasminogen activator lcsh:RC346-429 Brain Ischemia Fibrinolytic Agents medicine Predictive value of tests Humans Adults Medicine [Science] Thrombolytic Therapy Stroke lcsh:Neurology. Diseases of the nervous system Aged Retrospective Studies Univariate analysis Receiver operating characteristic business.industry General Medicine Thrombolysis Emergency department Middle Aged medicine.disease Thrombolytic therapy Cross-Sectional Studies Emergency medicine Administration Intravenous Female Neurology (clinical) business Emergency Service Hospital Clinical decision-making medicine.drug Research Article |
| Zdroj: | BMC Neurology BMC Neurology, Vol 20, Iss 1, Pp 1-9 (2020) |
| DOI: | 10.21203/rs.3.rs-22178/v1 |
| Popis: | Background Acute ischemic stroke is a time-sensitive emergency where accurate diagnosis is required promptly. Due to time pressures, stroke mimics, whom present with similar signs and symptoms as acute ischemic stroke, pose a diagnostic challenge to the emergency physician. With limited access to investigative tools, clinical prediction tools, based only on clinical features, may be useful to identify stroke mimics. We aim to externally validate the performance of 4 stroke mimic prediction scales and aim to derive a novel decision tree, to improve identification of stroke mimics. Methods We performed a retrospective cross-sectional study at a primary stroke centre, served by a telestroke hub. We included consecutive patients whom were administered intravenous thrombolysis for suspected acute ischemic stroke from January 2015 to October 2017. Four stroke mimic prediction tools (FABS, simplified FABS, Telestroke Mimic Score and Khan Score) were rated simultaneously, using only clinical information prior to administration of thrombolysis. The final diagnosis was ascertained by an independent stroke neurologist. Area under receiver operating curve (AUROC) analysis was performed. A classification tree analysis was also conducted using variables which were found to be significant in the univariate analysis. Results Telestroke Mimic Score had the highest discrimination for stroke mimics among the 4 scores tested (AUROC = 0.75, 95% CI = 0.63–0.87), although it was not statistically significantly better. Telestroke Mimic Score had the highest sensitivity (91.3%), while Khan score had the highest specificity (88.2%). All 4 scores had high positive predictive value (88.1–97.5%) and low negative predictive values (4.7–32.3%). A novel decision tree, using only age, presence of migraine and psychiatric history, had a higher prediction performance (AUROC = 0.80). Conclusion Four tested stroke mimic prediction scales performed similarly well to identify stroke mimics in the emergency setting. A novel decision tree may improve the identification of stroke mimics. |
| Databáze: | OpenAIRE |
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