Abstract Details

Title Altered Mental Status without Focal Neurological Deficit Is a Poor Predictor of True In-Hospital Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 235

Objective

Background BACKGROUND: In-hospital "stroke alerts" are activated when a patient's neurological status acutely deteriorates. Inpatient strokes represent an excellent potential opportunity for acute intervention and treatment, but over triaging mimics is a challenge.

Design/Methods DESIGN/METHODS: We retrospectively analyzed prospectively collected inpatient stroke team alerts over a study period then collected information on presenting symptoms, signs, nursing floor unit, and final diagnoses. Patients on neurological floors were excluded. The final diagnoses of the patients as stroke or stroke-mimic were determined by consensus. Chi-square, t-test, and binary multiple logistic regression were used for analysis.

Results RESULTS: Thirty-six of 93 (38.7%) stroke team calls were diagnosed with a stroke mimic. AMS was the leading reason for consultation in 33 of the 93 (35.5%) stroke alerts. Furthermore, 14 of the 33 calls (42.4%) for AMS were for patients without other focal neurological deficit. Only 1 of the 14 calls for AMS without focal deficit was diagnosed with acute/subacute stroke, three days post-cardiac arrest. The best predictors of stroke were a normal mental status (OR 5.88, p<.001) and a focal neurologic deficit (weak arm OR 4.19, p=.003; hemiparesis on exam OR 2.91, p=.032). The most common stroke mimics were toxic/metabolic encephalopathy (n=14), seizure (n=9), syncope (n=5) and sepsis (n=4).

Conclusions CONCLUSIONS: A normal mental status and a focal neurologic deficit best predict an acute in-hospital stroke. AMS is a frequent reason for activation of the stroke alert, however, AMS alone is a poor predictor of in-hospital stroke.

Authors/Disclosures
Pravin George, DO (Cleveland Clinic) PRESENTER	Dr. George has nothing to disclose.
Christopher R. Newey, DO (Sanford Health)	Dr. Newey has nothing to disclose.
Dolora R. Wisco, MD (Cleveland Clinic)	Dr. Wisco has nothing to disclose.
Lauri S. Soinne, MD, PhD, FAAN	Dr. Soinne has nothing to disclose.
James M. Gebel, MD (Akron General Medical Center)	No disclosure on file
Maryann Mays, MD, FAAN (Cleveland Clinic)	Dr. Mays has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Mays has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Oakley Health. Dr. Mays has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CoolTech Medical. Dr. Mays has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Dr. Mays has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Dynamed. The institution of Dr. Mays has received research support from Amgen. The institution of Dr. Mays has received research support from Lundbeck.

��ɫ��

��ɫ��