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Abstract Details

Separating Acute Stroke from Stroke Mimics in a TeleStroke Network: Differential Patient Characteristics and Exam Findings
Cerebrovascular Disease and Interventional Neurology
P07 - (-)
241
BACKGROUND: Acute teleneurology has largely focused on acute ischemic stroke (AIS) management ("TeleStroke"), but many patients referred for consultation have other non-stroke diagnoses, we highlight the differences between the two cohorts.
DESIGN/METHODS: We analyzed 2764 TeleStroke consultations from 2008-2011 from any of the 30 New England (MA, NH, ME) spokes in our Partners TeleStroke Network. Of these, 2137 (77.3%) were diagnosed with CVD. Baseline characteristics between the two groups were compared with univariate and multivariable models.
RESULTS: Among CVD cases, most were AIS (74.1%), followed by subacute ischemic stroke (13.3%), TIA (9.7 %) and hemorrhagic stroke (2.9%). In the non-CVD group, there were many diagnoses with the most common being seizure (16.2%) and migraine (16.0%). Compared to the CVD group, the non-CVD group were lower in mean age (56.5 vs. 67.8; p<0.001), frequently female (59.0% vs. 48.2%; p<0.001) with less hypertension (39.6% vs. 56.3%; p<0.001), hyperlipidemia (13.7% vs. 20.9%; p=0.027), prior stroke (17.3% vs. 25.0%; p=0.024) and atrial fibrillation (6.6% vs. 20.6%; p<0.001) and more prior seizures (7.6% vs. 2.6%; p=0.002). CVD patients were more likely to present with facial weakness (63.8% vs. 29.9%; p<0.001), limb weakness (72.1% vs. 52.3%; p<0.001) and speech disturbance (64.7% vs. 48.2%; p<0.001), while altered mental status (38.9% vs. 32.5%; p=0.101) was not different. Independent predictors of CVD were age [OR 1.03/year (1.02-1.040)], atrial fibrillation [OR 2.66 (1.15-6.13)], seizures history [OR 0.36 (0.13-0.99)] and facial weakness [OR 3.32 (2.00-5.51)].
CONCLUSIONS: As TeleStroke consultation expands, increasing numbers of non-CVD patients are being evaluated. These patients differ substantially from their CVD counterparts in their vascular risk profiles, and decision-support tools based on predictive models may help highlight these differences during these complex, time-critical evaluations.
Authors/Disclosures
Syed T. Ali, MBBS, BSc, MD (Syed T Ali MD PLLC)
PRESENTER 		No disclosure on file
Adam B. Cohen, MD (Massachusetts General Hospital) Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Thirty Madison. Dr. Cohen has received stock or an ownership interest from Thirty Madison.
Anand Viswanathan, MD (Massachusetts General Hospital) Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alnylam Pharmaceuticals. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Viswanathan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Pharmaceuticals.
Steven K. Feske, MD (Boston Medical Center, Neurology Department) Dr. Feske has received publishing royalties from a publication relating to health care.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Scott B. Silverman, MD (MGH) Dr. Silverman has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Law Firms.
David Y. Huang, MD, PhD, FAAN (The University of North Carolina) Dr. Huang has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ReNeuron. Dr. Huang has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for KMPHC.
Christopher D. Anderson, MD, PhD, FAAN (Brigham and Women's Hospital) The institution of Dr. Anderson has received research support from Bayer AG. The institution of Dr. Anderson has received research support from American Heart Association. The institution of Dr. Anderson has received research support from National Institutes of Health. An immediate family member of Dr. Anderson has received publishing royalties from a publication relating to health care.
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System) Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime 好色先生. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.