“Encephalopathy Only Stroke Codes” (EoSC) Rarely Result in Stroke as Final Diagnosis

Abstract

Stroke codes prompted by isolated encephalopathy often result in nonstroke final diagnoses but require intensive stroke center resources. We assessed the likelihood of “Encephalopathy only Stroke Codes (EoSC)” resulting in a true stroke (EoSC CVA+) final diagnosis. 3860 patients were analyzed in a prospective stroke code registry from 2004 to 2016. EoSC was defined using a standard and an exploratory definition. Definition 1 included EoSC patients as stroke codes where NIHSS was nonzero for LOC questions (questions la, 1b, and lc) but remainder of the NIHSS was zero. Definition 2 included the same definition but allowed symmetric pairings on motor questions (5a/5b, 6a/6b, or Question 4 scoring a 3). Groups were assessed for final diagnosis of stoke (EoSC CVA+) or not stroke (EoSC CVA-). EoSC accounted for 60/3860 (1.55%) of total stroke codes. EoSC CVA+ was found in 5/3860 (0.13%) of all stroke codes, 5/60 (8.33%) of EoSC stroke codes, and 5/1514 (0.33%) of all strokes. For Definition 2, EoSC accounted for 96/3860 (2.5%) of total stroke codes. EoSC CVA+ was found in 9/3860 (0.23%) of all stroke codes, 9/96 (9.38%) of EoSC stroke codes, and 9/1514 (0.59%) of all strokes. On multivariable logistic regression analysis, diabetes was the highest predictor of stroke (p=0.05). Encephalopathy only Stroke Codes only rarely result in cases with a true final diagnosis of stroke (EoSC CVA+), accounting for 0.1-0.2% of all stroke codes and 8-9% of EoSC stroke codes. This may have important significance for mobilization of limited acute stroke code resources in the future.

Encephalopathy only stroke codes (EoSC) do not result in rt-PA treatments

“…3 This study adds to the growing question of how can we improve the specificity of our intrinsically high sensitive stroke alert systems. 2 r Fig. 1.…”

“…Strokes characterized by isolated encephalopathy without other neurologic findings (EoSC+ Stroke+) account for only 0.1À0.2% of all stroke codes. 2 Whether this small cohort receives rt-PA or if these cases represent "missed opportunity" of rt-PA is unknown.…”

“…1 Encephalopathy only stroke codes (EoSC+) account for 1.5À2.5% of overall stroke codes and 8À9% of all encephalopathy only stroke codes. 2 While isolated encephalopathy is typically a stroke mimic, this symptom can very rarely be the presentation of bilateral, basilar or thalamic strokes.…”