Abstract WP395: Can Nursing-driven Stroke Alert Activations be Effective?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Nicole L Anderson ◽  
Amy L Castle ◽  
Ganesh Asaithambi
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Treatment Delays ◽  
Stroke Mimics ◽  
Intravenous Alteplase ◽  
Stroke Mimic ◽  
High Level ◽  
The Impact

Background: Earlier stroke alert activations in the emergency department can assemble needed resources quickly in order to shorten treatment delays among eligible patients. We compared the impact of nursing-driven stroke alert activations to EMS- or physician-directed stroke alert activations. Methods: From January 2015 to June 2016, we reviewed data from all emergency department stroke alert activations at an acute stroke ready hospital. We compared nursing (RN)-driven to paramedic (EMS)- and physician (MD)-driven stroke alert activations to determine rates of stroke mimic diagnoses at discharge and use of intravenous alteplase as well as median door-to-stroke alert, door-to-CT, and door-to-needle times. Results: There were 175 stroke alert activations during the study period (42 RN, 87 pre-hospital, 46 MD). Stroke mimics prompting stroke alert activations were not significantly different between RN- and EMS-activations (26.2% RN vs 34.5% EMS, p=0.42) but was significantly higher for MD activations (50% MD, p=0.04). Compared to RN-activations, EMS-activations had shorter door to stroke alert (-7 [-10, -5] minutes EMS vs 4 [1, 7] minutes RN, p<0.01) and door to CT (0 minutes EMS vs 14 [8, 16] minutes RN, p<0.01) times; MD-activations had longer door to stroke alert (11.5 [6, 22] minutes MD, p<0.01) and door to CT (20.5 [14, 30.75] minutes MD, p<0.01). Door-to-needle times were similar between RN- and MD-activations (51 [38, 54] minutes RN vs 58 [49, 63] MD, p=0.25); there was a trend towards quicker DNTs for EMS-activations (39 [31, 43] minutes EMS, p=0.057). Rates of alteplase usage were similar for RN-activations (19%) compared to EMS- (12.6%, p=0.43) and MD- (23.9%, p>0.99) activations. Conclusion: Because of a high level of accuracy, nursing-driven stroke alert activations should be encouraged if indicated in order to shorten stroke alert time metrics when pre-hospital alerts have not occurred. Further studies are needed to examine the impact of nursing-driven stroke alert activations.

Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Nicolle W Davis ◽  
Meghan Bailey ◽  
Natalie Buchwald ◽  
Amreen Farooqui ◽  
Anna Khanna
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Patient Outcomes ◽  
Time Of Day ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
The Impact ◽  
Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

scholarly journals Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew M. Penn ◽  
Nicole S. Croteau ◽  
Kristine Votova ◽  
Colin Sedgwick ◽  
Robert F. Balshaw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Transient Ischemic Attack ◽  
Final Diagnosis ◽  
Conditional Inference ◽  
Minor Stroke ◽  
Logistic Regression Models ◽  
Stroke Mimics ◽  
Stroke Mimic ◽  
Ischemic Attack

Abstract Background Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. Methods A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. Results Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00–1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12–1.35) in those 60–79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89–1.07). Conclusions Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians’ suspicion of TIA/MS. Trial registration ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.

STROKE MIMICS: A PSYCHOGENIC STROKE PATIENT TREATED WITH ALTEPLASE

2019 ◽  
Vol 17 (1) ◽  
pp. 97-102
Author(s):  
Dariusz Kotlęga ◽  
Barbara Peda ◽  
Tomasz Trochanowski ◽  
Monika Gołąb-Janowska ◽  
Sylwester Ciećwież ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Conversion Disorder ◽  
Initial Diagnosis ◽  
Therapeutic Window ◽  
Stroke Mimics ◽  
Conversion Disorders ◽  
Proper Diagnosis ◽  
Intravenous Alteplase ◽  
The Subject ◽  
Stroke Mimic

For rtPA treatment to be effective it should be initiated within the first 4.5 hours following the onset of a stroke. Such a short therapeutic window demands a rapid diagnosis and decision making on the part of the physician. There are patients with stroke-like symptoms and an initial diagnosis of a stroke, but who are finally diagnosed as suffering from another condition. According to the subject literature, stroke mimics are diagnosed in about 1.4 – 3.5% of patients initially diagnosed as having had an ischemic stroke. Psychogenic strokes (conversion disorders) may be found in as many as 8.2% of stroke patients. Proper diagnosis is especially important in patients eligible for thrombolytic treatment when there is usually not enough time to establish the diagnosis of a stroke mimic, especially one of psychogenic origin. A patient with an initial diagnosis of an ischemic stroke who was treated with intravenous alteplase infusion. The previous two ischemic strokes treated in the same manner had been diagnosed one and two years earlier. In all hospitalizations no rtPA treatment complications had been observed. In our patient a proper neuropsychological examination was performed and a conversion disorder diagnosed. We would like to underline the importance of cooperation between the neuropsychologist and neurology physician within clinical practice.

scholarly journals 01 Development and validation of a pragmatic prehospital tool to identify stroke MIMIC patients

2019 ◽  
Vol 36 (1) ◽  
pp. e1.1-e1
Author(s):  
Graham McClelland ◽  
Darren Flynn ◽  
Helen Rodgers ◽  
Chris Price
Keyword(s):  
Clinical Characteristics ◽  
List Type ◽  
Stroke Patients ◽  
Stroke Mimics ◽  
Primary Hospital ◽  
Stroke Services ◽  
Suspected Stroke ◽  
Stroke Mimic ◽  
High Level ◽  
Development And Validation

BackgroundStroke mimics (SM) are non-stroke conditions producing similar symptoms to stroke. Prehospital stroke identification tools prioritise sensitivity over specificity, therefore >25% of prehospital suspected stroke patients are SM. Failure to identify SM Results in inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool for paramedics, using information often available in the prehospital setting, to identify SM amongst suspected stroke patients.MethodsThe initial tool was developed using a systematic literature review to identify SM characteristics, a survey of UK paramedics to explore the acceptability of SM identification and regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to their primary hospital diagnoses (n=1,650, 40% SM).The initial tool was refined using two focus groups with paramedics (n=3) and hospital clinicians (n=9) and analysis of an expanded prehospital dataset (n=3,797, 41% SM) to produce the final STEAM tool.ResultsSTEAM scores six variables:1 point for Systolic blood pressure <90 mmHg1 point for Temperature >38.5°C with heart rate >90 bpm1 point for seizures or 2 points for seizures with diagnosed Epilepsy1 point for Age <40 years or 2 points for age <30 years1 point for headache with diagnosed Migraine1 point for FAST–veA score of ≥2 on STEAM predicted SM diagnosis in the expanded derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. STEAM was validated using an external dataset (n=1,848, 33% SM) of prehospital suspected stroke patients where STEAM was 5.5% sensitive, 99.4% specific with a PPV of 82.5%.ConclusionsSTEAM uses common clinical characteristics to identify a small number of SM patients with a high level of certainty. The benefits of reducing SM admissions to specialist stroke services should be weighed against delayed admission for the small number of stroke patients identified as a SM.

Migraine with Aura as a Stroke Mimic

2019 ◽  
Vol 47 (2) ◽  
pp. 242-244
Author(s):  
Jeong-Jin Park ◽  
Soo Jeong Kim ◽  
Hahn Young Kim ◽  
Hong Gee Roh ◽  
Dong Wook Kim
Keyword(s):  
Atrial Fibrillation ◽  
Acute Stroke ◽  
Migraine Attack ◽  
Migraine With Aura ◽  
Medical Records ◽  
Final Diagnosis ◽  
Stroke Management ◽  
Stroke Mimics ◽  
Management Protocol ◽  
Stroke Mimic

ABSTRACT:Migraine with aura is one of the causes of stroke mimics. We retrospectively reviewed the 10-year medical records of patients who were treated with acute stroke management protocol. We analyzed the frequency and characteristics of patients with a final diagnosis of migraine with aura. Among the 1355 patients with stroke mimics, migraine with aura was the final diagnosis in 36 patients (2.7%). The most common auras included sensory and brainstem auras followed by motor, visual, and speech/language auras. One patient manifested transient atrial fibrillation during the migraine attack, which can be a link with acute stroke.

Stroke mimic in an acute rehabilitation unit patient with associated hypomagnesaemia

2021 ◽  
Vol 14 (4) ◽  
pp. e239777
Author(s):  
Mia X Shan ◽  
Andrew Hanna ◽  
Emmanuel G Villalpando ◽  
Dixie Aragaki
Keyword(s):  
Emergency Department ◽  
Comprehensive Evaluation ◽  
Rehabilitation Unit ◽  
Stroke Mimics ◽  
Laboratory Results ◽  
Acute Infarct ◽  
Facial Numbness ◽  
Stroke Mimic ◽  
Acute Rehabilitation ◽  
Work Up

This case report describes a patient who presented with acute left facial numbness and eyelid weakness prompting work-up, which demonstrated low suspicion for new stroke but revealed hypomagnesaemia as a potential differential diagnosis. Patient initially presented to the emergency department with left upper extremity weakness and was diagnosed with right basal ganglia infarction. Two weeks after transfer to the acute rehabilitation unit, patient suddenly complained of left facial numbness and eyelid weakness. However, brain imaging did not show any new acute infarct. Instead, laboratory results showed hypomagnesaemia at 1.50 mg/dL. Patient was therefore treated with intravenous magnesium leading to resolution of his symptoms. Up to 30% of acute stroke presentations are stroke mimics. Although hypomagnesaemia is less frequently seen as a mimic, its neuromuscular manifestations may present with similar symptoms. Patients will always benefit from a comprehensive evaluation for stroke symptoms, but it is important to consider the mimics as well.

Abstract TP250: A Substantial Rate of Neurological and Non-Neurological Stroke Mimics Are Transported by Emergency Medical Services for Acute Stroke Evaluation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joel N Briard ◽  
Rahel T Zewude ◽  
Mahesh Kate ◽  
Ken Butcher ◽  
Laura C Gioia
Keyword(s):  
Acute Stroke ◽  
Emergency Medical Services ◽  
Final Diagnosis ◽  
Medical Services ◽  
Cross Sectional ◽  
Stroke Mimics ◽  
Emergency Medical ◽  
Number Of Patients ◽  
Suspected Stroke ◽  
The Impact

Introduction: The impact of prehospital triage of stroke mimics to designated stroke centers may be considerable, yet little information exists regarding stroke mimics in the prehospital setting. We aimed to describe the rate and clinical characteristics of neurological and non-neurological stroke mimics transported by Emergency Medical Services (EMS) to the Emergency Department (ED) for acute stroke evaluation. Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database of patients transported by EMS to the ED for suspected stroke during an 18-month period. Hospital charts and neuroimaging were utilized to determine the final diagnosis (acute stroke, stroke mimic, as well as specific underlying diagnoses). Results: A total of 960 patients were transported by EMS to the ED with suspected stroke, among whom 405 (42.2%) were stroke mimics (mean age ± SD: 66.9 ± 17.1 years; 54% male). Stroke mimics were neurological in origin in 223 (55.1%) patients and non-neurological in 182 (44.9%). Most common neurological diagnoses were seizures (n=44,19.7%), migraines (n=42,18.8%) and peripheral neuropathies (n=25, 11.2%). Most common non-neurological mimics included cardiovascular (15.9%), psychiatric (11.9%), and infectious (8.9%) diagnoses. Neurological mimics were younger (64.1 ± 17.3 years) than non-neurological mimics (70.5 ± 16.1 years, p<0.001). Median prehospital Glasgow Coma Scale scores were similar between groups (15 vs. 15, p=0.26). Mean prehospital systolic blood pressure was slightly higher in neurological (147.8±24.2 mmHg) than non-neurological mimics (141.2±26.2 mmHg, p=0.01). Conclusions: Stroke mimics represent a substantial number of patients transported by EMS for suspected stroke, with a considerable amount being non-neurological in origin. Prospective prehospital studies are warranted to help refine prehospital identification of acute stroke and thus minimize the number of stroke mimics transported by EMS for acute stroke evaluation.

The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms

2017 ◽  
Vol 45 ◽  
pp. 65-70 ◽  
Author(s):  
Stephanie E. Honig ◽  
Lukasz S. Babiarz ◽  
Evan L. Honig ◽  
Saeedeh Mirbagheri ◽  
Victor Urrutia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
The Impact

An Important Pediatric Stroke Mimic: Hemiplegic Migraine

2020 ◽  
Vol 47 (2) ◽  
pp. 235-236
Author(s):  
Michael T. Jurkiewicz ◽  
Arastoo Vossough ◽  
Avrum N. Pollock
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Pediatric Stroke ◽  
Hemiplegic Migraine ◽  
Motor Weakness ◽  
Migraine Headaches ◽  
Stroke Mimic

Stroke is relatively rare in children but has become increasingly recognized clinically. Hemiplegic migraine (HM) is a rare subtype of migraine, with attacks typically beginning in childhood or adolescence. Attacks are characterized by migraine headaches and motor weakness, which develop over several minutes. HM may therefore mimic acute stroke; however, symptoms last less than an hour and resolve spontaneously, often without sequela.1–4 Distinction between these entities is important due to their different urgency and management. Neuroimaging is indispensible in working up patients presenting to the Emergency Department with stroke-like symptoms and can be used to distinguish between infarction and HM.

scholarly journals Intravenous Thrombolysis for a Stroke Mimic Patient

2021 ◽  
pp. 704-709
Author(s):  
Lilly Nguyen ◽  
Joyce Hoonsuh Lee ◽  
Latha Ganti ◽  
Mark Rivera-Morales ◽  
Larissa Dub
Keyword(s):  
Cerebrovascular Disease ◽  
Acute Stroke ◽  
Plasminogen Activator ◽  
Young Woman ◽  
Intravenous Thrombolysis ◽  
Herbal Supplements ◽  
Stroke Mimics ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Stroke Mimic

The authors present the case of a young woman on phentermine and herbal supplements who presented as an acute stroke alert with right-sided facial droop and numbness. She was treated acutely with intravenous tissue plasminogen activator (tPA). However, the workup did not reveal any evidence of cerebrovascular disease or cerebral infarct. The authors discuss plausible stroke mimics and the safety of administering tPA to such patients.

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