scholarly journals Changing Demographics of Stroke Mimics in Present Day Stroke Code Era: Need of a Streamlined Clinical Assessment for Emergency Physicians

2021 ◽  
Author(s):  
Kaushik Sundar ◽  
Ajay Panwar ◽  
Lomesh Bhirud ◽  
Eldho Mathew Paul ◽  
Paul J. Alapatt ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Female Gender ◽  
Rapid Response ◽  
Emergency Physicians ◽  
Clinical Predictors ◽  
Stroke Mimics ◽  
High Incidence ◽  
Stroke Mimic ◽  
Changing Demographics ◽  
Strong Independent Predictor

Abstract Background There is an apparently high incidence of stroke mimics in the present-day stroke code era. The reason being is the intense pressure to run with time to achieve the ̒̒time is brain”-based goals.Methods The present study was a retrospective analysis of the data collected over a duration of 6 months from April 2019 to September 2019. We observed the incidence of stroke mimics among the patients for whom rapid response stroke code was activated during the study period. We also performed a logistic regression analysis to identify the clinical features which can act as strong predictors of stroke and mimics. Results A total of 314 stroke codes were activated of which 256 (81.5%) were stroke and 58 (18.5%) were the mimics. Functional disorders and epilepsy were the most common mimics (24.1% each). Female gender (p = 0.04; odds ratio [OR] 2.9[1.0–8.8]), isolated impairment of consciousness (p < 0.01; OR 4.3[1.5–12.6]), and isolated dysarthria (p < 0.001) were the strong independent predictors for a stroke mimic. Hemiparesis was the strong independent predictor for a stroke (p < 0.001; OR 0.0[0.0–0.1]). Conclusion In the present epoch of rapid response stroke management, a streamlined assessment by the emergency physicians based on the above clinical predictors may help in avoiding the misdiagnosis of a mimic as stroke.

scholarly journals Identification of Stroke Mimics in the Emergency Department Setting

2009 ◽  
Vol 1 ◽  
pp. JCNSD.S2280 ◽  
Author(s):  
W. Oliver Tobin ◽  
Joseph G. Hentz ◽  
Bentley J. Bobrow ◽  
Bart M. Demaerschalk
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Clinical Predictors ◽  
Acute Stroke Care ◽  
Stroke Mimics ◽  
Emergency Department Setting ◽  
Multivariable Regression ◽  
Stroke Mimic ◽  
Stroke Centre

Background and Purpose Previous studies have shown a stroke mimic rate of 9%–31%. We aimed to establish the proportion of stroke mimics amongst suspected acute strokes, to clarify the aetiology of stroke mimic and to develop a prediction model to identify stroke mimics. Methods This was a retrospective cohort observational study. Consecutive “stroke alert” patients were identified over nine months in a primary stroke centre. 31 variables were collected. Final diagnosis was defined as “stroke” or “stroke mimic”. Multivariable regression analysis was used to define clinical predictors of stroke mimic. Results 206 patients were reviewed. 22% were classified as stroke mimics. Multivariable scoring did not help in identification of stroke mimics. 99.5% of patients had a neurological diagnosis at final diagnosis. Discussion 22% of patients with suspected acute stroke had a stroke mimic. The aetiology of stroke mimics was varied, with seizure, encephalopathy, syncope and migraine being commonest. Multivariable scoring for identification of stroke mimics is not feasible. 99.5% of patients had a neurological diagnosis. This strengthens the case for the involvement of stroke neurologists/stroke physicians in acute stroke care.

scholarly journals The extreme capsule and aphasia: proof-of-concept of a new way relating structure to neurological symptoms

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Ariane Martinez Oeckel ◽  
Michel Rijntjes ◽  
Volkmar Glauche ◽  
Dorothee Kümmerer ◽  
Christoph P Kaller ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Study Cohort ◽  
Proof Of Concept ◽  
Stroke Patients ◽  
Functional Regions ◽  
Lesion Mapping ◽  
Ventral Pathway ◽  
Token Test ◽  
Strong Independent Predictor ◽  
Language Network

Abstract We present anatomy-based symptom-lesion mapping to assess the association between lesions of tracts in the extreme capsule and aphasia. The study cohort consisted of 123 patients with acute left-hemispheric stroke without a lesion of language-related cortical areas of the Stanford atlas of functional regions of interest. On templates generated through global fibre tractography, lesions of the extreme capsule and of the arcuate fascicle were quantified and correlated with the occurrence of aphasia (n = 18) as defined by the Token Test. More than 15% damage of the slice plane through the extreme capsule was a strong independent predictor of aphasia in stroke patients, odds ratio 16.37, 95% confidence interval: 3.11–86.16, P &lt; 0.01. In contrast, stroke lesions of &gt;15% in the arcuate fascicle were not associated with aphasia. Our results support the relevance of a ventral pathway in the language network running through the extreme capsule.

Abstract 14767: Thrombolysis of Stroke Mimics via Telestroke

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ravyn Howell ◽  
Randheer S Yadav ◽  
Sushil Lakhani ◽  
Sharon Heaton ◽  
Karen L Wiles ◽  
...  
Keyword(s):  
Final Diagnosis ◽  
National Institutes Of Health ◽  
Factitious Disorder ◽  
Emergency Rooms ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Stroke Diagnosis ◽  
History Of ◽  
Stroke Mimic ◽  
Similar Episode

Introduction: Telestroke allows stroke expertise for thrombolysis decision making remotely using high-quality bidirectional audiovisual technology. Hypothesis: Intravenous tissue plasminogen activator (IVtPA) is administered via telestroke network to a proportion of patients without a stroke diagnosis (i.e. stroke mimic) Methods: Our academic comprehensive stroke program telestroke program includes 26 spoke Emergency rooms (ERs) through which IVtPA is administered throughout central Ohio. From July 1, 2016 to Sept 30, 2017, nearly all patients who received IVtPA at the outside hospital telestroke ERs were transferred to our institution for post-IVtPA care. Data was collected on final diagnosis, demographics, National Institutes of Health Stroke Scale (NIHSS), door to needle (DTN) time, and outcomes. Results: Among 270 acute ischemic stroke patients who received IVtPA via telestroke, we identified 64 (23.7%) with a stroke mimic diagnosis. Stroke mimics were younger (mean age 56.4 vs 68.2, p <0.0001), more likely female (60.9% vs 45.6%, p 0.03), and had higher DTN times (85.3 vs 69.9 minutes, p 0.0008). The increase in DTN was due to longer time to recommend by the telestroke neurologist for stroke mimic (65.0 vs 53.2 minutes, p 0.0034). The stroke mimic diagnosis included Migraine 26 (40.6%), Factitious disorder 12 (18.8%), Encephalopathy 7 (10.9%), and Unmasking 6 (9.4%). The stroke mimics did not differ from each other based upon initial NIHSS, DTN, or sex. Compared to the other stroke mimics, Migraine and Factitious disorder patients were younger (51.2 vs 63.9 years, p <0.0006), more likely to have a personal history of migraines (42.1% vs 0%, p < 0.0001), and more likely to have functional exam findings (42.1% vs 3.8%, p 0.0007). There were no hemorrhagic complications in the stroke mimic patients. Among all stroke mimics, 26 (40.6%) had a history of similar prior episodes and 10 (15.6%) would have future recurrence of another similar episode, with 2 patients receiving IVtPA again in the future (1 Migraine and 1 Factitious disorder). Conclusions: In a tertiary academic telestroke network, nearly one-quarter of patients receive IVtPA for a non-stroke diagnosis, with migraine and factitious disorder being the most commonly seen.

scholarly journals High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody–associated Vasculitis

2018 ◽  
Vol 46 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Amy Kang ◽  
Marilina Antonelou ◽  
Nikki L. Wong ◽  
Anisha Tanna ◽  
Nishkantha Arulkumaran ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Independent Predictor ◽  
Antineutrophil Cytoplasmic Antibody ◽  
First Year ◽  
High Incidence ◽  
All Cause Mortality ◽  
Coronary Events ◽  
The Uk ◽  
Event Rates

Objective.To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).Methods.This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.Results.There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1–10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.Conclusion.Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.

scholarly journals An Observational Cohort Study ofClostridium difficileRibotype 027 and Recurrent Infection

mSphere ◽  
2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Krishna Rao ◽  
Peter D. R. Higgins ◽  
Vincent B. Young
Keyword(s):  
Logistic Regression ◽  
Independent Predictor ◽  
The United States ◽  
Public Health Issue ◽  
Clinical Microbiology Laboratory ◽  
Clinical Predictors ◽  
Content Type ◽  
Ribotype 027 ◽  
Increased Risk ◽  
Wide Range

ABSTRACTRecurrentClostridium difficileinfection (rCDI) frequently complicates recovery from CDI. Accurately predicting rCDI would allow judicious allocation of limited resources, but published models have met with limited success. Thus, biomarkers predictive of recurrence have been sought. This study tested whether PCR ribotype independently predicted rCDI. Stool samples from nonpregnant inpatients ≥18 years of age with diarrhea were included from October 2010 to January 2013 after the patients tested positive forC. difficilein the clinical microbiology laboratory. Per guidelines, the rCDI was defined as a positive test forC. difficileat >2 weeks but ≤8 weeks from the index episode. For each sample, a single colony ofC. difficilewas isolated by anaerobic culture, confirmed to be toxigenic by PCR, and ribotyped. Simple logistic regression and multiple logistic regression were used to model the primary outcome of rCDI, incorporating a wide range of clinical parameters. In total, 927 patients with 968 index episodes of CDI were included, with 110 (11.4%) developing rCDI. Age and use of proton pump inhibitors or concurrent antibiotics did not increase the risk of rCDI. Low serum bilirubin levels and ribotype 027 were associated with increased risk of rCDI on unadjusted analysis, with health care-associated CDI being inversely associated. In the final multivariable model, ribotype 027 was the strongest independent predictor of rCDI (odds ratio, 2.17; 95% confidence interval, 1.33 to 3.56;P= 0.002). Ribotype 027 is an independent predictor of rCDI.IMPORTANCECDI is a major public health issue, with over 400,000 cases per year in the United States alone. Recurrent CDI is common, occurring in approximately one in five individuals after a primary episode. Although interventions exist that could reduce the risk of recurrence, deployment in all patients is limited by cost, invasiveness, and/or an undetermined long-term safety profile. Thus, clinicians need risk stratification tools to properly allocate treatments. Because prior research on clinical predictors has failed to yield a reliable, reproducible, and effective predictive model to assist treatment decisions, accurate biomarkers of recurrence would be of great value. This study tested whether PCR ribotype independently predicted rCDI, and the data build upon prior research in showing that ribotype 027 is associated with rCDI.

scholarly journals Clinical predictors of methicillin-resistance and their impact on mortality associated with Staphylococcus aureus bacteraemia

2018 ◽  
Vol 146 (10) ◽  
pp. 1326-1336 ◽  
Author(s):  
Y. M. Wi ◽  
J. Y. Rhee ◽  
C. I. Kang ◽  
D. R. Chung ◽  
J. H. Song ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Characteristics ◽  
Independent Predictor ◽  
Methicillin Resistance ◽  
Antibiotic Use ◽  
Clinical Predictors ◽  
Clinical Difference ◽  
Epidemiological Risk ◽  
Patients At Risk ◽  
Community Onset

AbstractWe investigated the clinical predictors of methicillin-resistance and their impact on mortality in 371 patients with Staphylococcus aureus bacteraemia identified from two prospective multi-centre studies. Methicillin resistant S. aureus (MRSA) accounted for 42.2% of community-onset and 74.5% of hospital-onset cases. No significant clinical difference was found between patients infected with MRSA vs. methicillin-sensitive S. aureus (MSSA), except that the former were more likely to have had hospital-onset bacteraemia and received antibiotics in the preceding 90 days. After stratifying according to the acquisition site, prior antibiotic use was the only independent predictor of having MRSA in both community-onset and hospital-onset cases. The frequency of inappropriate empirical antibiotic therapy was higher in patients with MRSA than in those with MSSA bacteraemia. However, methicillin resistance was not a predictor of mortality in patients and the clinical characteristics and outcomes of both MRSA and MSSA bacteraemia were similar. This study indicates that there are no definitive clinical or epidemiological risk factors which could distinguish MRSA from MSSA cases with the exception of the previous use of antibiotics for having MRSA bacteraemia, which emphasises the prudent use of glycopeptide treatment of patients at risk for invasive MRSA infections.

scholarly journals Construction and Validation of Nomograms for Predicting the Prognosis of Juvenile Osteosarcoma: A Real-World Analysis in the SEER Database

2020 ◽  
Vol 19 ◽  
pp. 153303382094771
Author(s):  
Yao Jiang ◽  
Tianyu Wang ◽  
Zizheng Wei
Keyword(s):  
Predictive Performance ◽  
Seer Database ◽  
Clinical Predictors ◽  
Malignant Bone Tumors ◽  
Cancer Specific Survival ◽  
Training Cohort ◽  
Ajcc Stage ◽  
High Incidence ◽  
Css Construction ◽  
Cox Analysis

Background: Osteosarcoma is one of the most common malignant bone tumors, with a high incidence in adolescence. The objective of this study was to construct prognostic nomograms for predicting the prognosis of juvenile osteosarcoma. Methods: Patients with osteosarcoma diagnosed between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The essential clinical predictors were identified with univariate and multivariate Cox analysis. Nomograms were constructed to predict the 3- and 5-year cancer- specific survival (CSS) and overall survival (OS). Concordance index (C-index) and calibration plots were performed to validate the predictive performance of nomograms. Results: We enrolled 736 adolescents with osteosarcoma from the SEER database, with 516 samples grouped into a training cohort and 220 samples grouped into a validation cohort. In multivariate analysis of the training cohort, predictors including tumor size, surgery treatment and AJCC stage were found to be associated with OS and CSS, while age was only associated with CSS. Construction of nomograms based on these predictors was performed to evaluate the prognosis of adolescents with osteosarcoma. The C-index and calibration curves also showed the satisfactory performance of these nomograms for prognosis prediction. Conclusion: The developed nomograms are useful tools for precisely predicting the prognosis of adolescents with osteosarcoma, which could enable patients to be more accurately managed in clinical practice.

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