Prehospital assessment of suspected stroke and TIA: An observational study

Abstract

Background Symptoms related to stroke diverge and may mimic many other conditions. Aims To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). Methods An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four‐month period were included. Results Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five‐year follow‐up. Conclusions Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.

TOAST classification and risk factors of ischemic stroke in Lebanon

“…The prevalence of TIA in our cohort was 4%. This is lower than that of previous studies reporting the TIA prevalence of 9% and 11% …”

Stroke mimics: incidence, aetiology, clinical features and treatment

“…Stroke mimics were the diagnosis in 31% of 1081 in a recent study from Sweden. Epilepsy, infections, brain tumours and sequelae of prior stroke were the most common final diagnosis [35]. The presence of physicians in the ambulance seems to marginally improve the rates of diagnosis of ischaemic stroke.…”

Profile of practices and knowledge on stroke among Polish emergency medical service staff

“…Stroke mimic is a non-vascular disease characterized by acute neurological deficits comparable to those associated with stroke. According to several small studies, up to one-third of patients evaluated acutely by a stroke team and up to 15% of patients treated with intravenous tissue plasminogen activator (t-PA) have such stroke mimics; possible etiologies include seizures, tumors, migraine, infections, delirium, peripheral nerve injuries, multiple sclerosis, and conversion disorders [12][13][14].…”