Abstract Details

Title Implications of Hemisensory Stroke Symptoms in Patients Undergoing Emergency Evaluation for Chest Pain

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 246

Objective

Background BACKGROUND: We informally observed that ED evaluation of patients presenting with CP and SS is always negative.

Design/Methods DESIGN/METHODS: After IRB approval, we reviewed charts of patients presenting to our ED within the past 5 years with principal diagnosis of CP (ICD9: 786.5, 786.59) and secondary diagnosis of SS (782.0).

Results RESULTS: Fifty five patients were identified. Evaluation was negative in all. Distinguishing features: arrived by personal vehicle (82%), young (median age 41). Minimal vascular risk (%): female (68), hypertension (38), diabetes (20), dyslipidemia (18), smoking (14), history of organic heart or brain disease (12, 16). CP unusual (%): chronic recurrent (90); mean duration 1.68 days; pain sharp (33), fluctuating (42); severity mild/moderate (89); accompanied by headache (34); unresponsive to treatment in ED (46); prior ED visits for CP (28). SS unusual (%): left sided (86), nonobjectifiable exam. All patients had negative EKG, enzymes, chest radiograph, head CT. Tests also negative for additional modalities (% tested): head and neck CTA (34); neurology consult (24); chest CT (18). Process times (mean minutes): brain imaging 35; chest CT 40; neurology consultation 50. Total ED = 5 hours, 41 minutes. Discharged home 70%. Admitted for observation 30%: negative stress testing, MRI brain scan, attending level consultation in all; median length of stay 2 days.

Conclusions CONCLUSIONS: In this single institution analysis of 55 patients, the co-presentation of CP and SS predicted negative evaluation for both complaints. Prospective validation of a profile of these patients could save costs of imaging and neurology consultation; substantially reduce total ED time; and eliminate the need and cost of hospitalization. Study of the presentation of chest pain associated with other neurological symptoms could prove to be of similar value.

Authors/Disclosures
James L. Frey, MD, FAAN PRESENTER	No disclosure on file
	No disclosure on file
Christina L. Saldivar, MD (St. Davids Neurology)	No disclosure on file
Kamala Saha, MD, FAAN	Dr. Saha has nothing to disclose.
Joni M. Clark, MD (Eisenhower Medical Center)	No disclosure on file
	No disclosure on file
Luis F. Orozco-Cabal	No disclosure on file
Douglas L. Arnold, MD, FAAN (Montreal Neurological Institute, McGill Univ)	Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xfacto communications. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Find therapeutics. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Idorsia. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniksa. Dr. Arnold has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Clario.

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