Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Barra, Mathias; Faiz, Kashif Waqar; Dahl, Fredrik A.; Næss, Halvor

doi:10.1111/ane.13527

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…3.). It is estimated that mimics may be responsible for more than 50% of stroke suspected admissions [36,42,43]. In comparison to stroke, the majority of its mimics are not the reason for direct threat to patients' life.…”

Section: Limitations and Disadvantagesmentioning

confidence: 99%

The clinical relevance assessment of ROSIER scale in emergency care

Woszczyk

Kłosiewicz

2022

Medical Research Journal

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Stroke incidence and its consequences are nowadays a common cause of death, disability and financial burden for the health system. The scale of this phenomenon is estimated to increase in further years.To ensure the best patients care, therapy should be applied in a dedicated stroke unit as soon as possible.Nevertheless, even 2 out of 3 suspected patients visit the emergency department in the first place. The probable lack of knowledge and experience from the personnel indicates up to a 60% rate of misdiagnosis resulting in delays in treatment administration and consequently a reduction of chance for survival and full recovery. The Recognition of Stroke in the Emergency Room scale has been developed to improve the emergency physicians' assessment. It evaluates the initial event history and physical examination, which translates into a score from -2 to 5 with a > 0 cut-off point anticipating a high probability of stroke. Simple construction assures easy use and evaluation quality by all emergency staff members. The scale shows satisfactory accuracy, which establishes its superiority over the basic neurological examination, Face Arm Speech Time Test (FAST), and Cincinnati Prehospital Stroke Scale (CPSS) proven in several studies.On the contrary, the application is considerably reduced in cases of hemorrhage stroke, transient ischemic attack (TIA) and posterior circulation infarct in both adult and pediatric patients. Despite those limitations, the Recognition of Stroke in the Emergency Room Scale (ROSIER) scale constitutes a valuable instrument that can improve the insufficient stroke recognition rate and following patients' prognosis.

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Section: Limitations and Disadvantagesmentioning

confidence: 99%

The clinical relevance assessment of ROSIER scale in emergency care

Woszczyk

Kłosiewicz

2022

Medical Research Journal

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Stroke unit demand in Norway – present and future estimates

Dahl

Barra

Faiz

et al. 2022

BMC Health Serv Res

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Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates for stroke incidence and time constant estimates for length of stay (LOS) were estimated from the Norwegian Patient Registry (2010–2015). Incidence and LOS models for SMs were based on data from Haukeland University Hospital (2008–2017) and Akershus University Hospital (2020), respectively. The incidence and LOS models were combined with scenarios from Statistic Norway’s population predictions to estimate SU demands for each health region. A telephone survey collected data on the number of currently available SU beds. Results In 2020, 361 SU beds are available, while demand was estimated to 302. The models predict a reduction in stroke incidence, which offsets projected demographic shifts. Still, the estimated demand for 2040 rose to 316, due to an increase in SMs. A variation of this reference scenario, where stroke incidence was frozen at the 2020-level, gave a 2040-demand of 480 beds. Conclusions While the stroke incidence is likely to continue to fall, this appears to be balanced by an increase in SMs. An important uncertainty is how long the trend of decreasing stroke incidence can be expected to continue. Since the most important uncertainty factors point toward a potential increase, which may be as large as 50%, we would recommend that the health authorities plan for a potential increase in the demand for SU bed capacity.

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A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate

Moroni,

Vannucchi,

Vinci

et al. 2024

Ital J Med

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Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.

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Stroke Mimics on the Stroke Unit – Temporal trends 2008–2017 at a large Norwegian university hospital

Cited by 3 publications

References 47 publications

The clinical relevance assessment of ROSIER scale in emergency care

The clinical relevance assessment of ROSIER scale in emergency care

Stroke unit demand in Norway – present and future estimates

A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate

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