Abstract Details

Title A Clinical Paradigm for Classifying Neurologic Symptoms to Screen for Emergent Large Vessel Occlusions

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-046

Objective To create a simple triage system that would effectively screen for thrombectomy candidacy in patients who present to the emergency department as acute stroke alerts.

Background With newly-extended treatment windows for endovascular therapy in emergent large vessel occlusions, it is increasingly important to identify thrombectomy-eligible patients without overwhelming resources dedicated to acute stroke care. We devised a simple paradigm to classify patient's presenting neurologic symptoms to screen for large vessel occlusions.

Design/Methods

We reviewed the presenting symptoms, imaging findings, and final diagnoses of consecutive emergency department stroke alert cases. Patients were classified based on their neurologic exams as focal objective, focal subjective, or non-focal. Outcomes of final diagnoses of acute ischemic stroke and large vessel occlusions were compared across groups. Comparisons were made to other large vessel occlusion prediction scales.

Results Of 521 patients, 342 (65.6%) were categorized as focal objective, 142 (27.2%) as focal subjective, and 37 (7.1%) as non-focal. Ischemic stroke and large vessel occlusions were diagnosed in 114 (21.9%) and 27 (5.2%) of patients, respectively. Classification as focal objective significantly predicted stroke (odds ratio 3.77; 95% confidence interval 2.17-6.55) and captured all large vessel occlusions (p=0.0001). The focal objective categorization was the only tool which achieved 100% sensitivity for large vessel occlusions (with a specificity of 36%) compared to other large vessel occlusion prediction tools.

Conclusions Patients who presented as stroke alerts without focal neurologic symptoms were unlikely to have large vessel occlusions. With high sensitivity, classifying patients' neurologic exams into focal objective versus subjective or non-focal categories may serve as a useful tool to screen for large vessel occlusions and prevent unnecessary emergent workup in patients unlikely to be endovascular candidates.

Authors/Disclosures
Rebecca Pollard, MD (University of Pittsburgh Medical Center) PRESENTER	Dr. Pollard has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of Clinical and Translational Neurology.
Michelle H. Leppert, MD	Dr. Leppert 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 Journal of American Heart Association. The institution of Dr. Leppert has received research support from Colorado Clinical and Translational Sciences Institute. The institution of Dr. Leppert has received research support from American Heart Association. Dr. Leppert has a non-compensated relationship as a Chair with Colorado Stroke Advisory Board that is relevant to AAN interests or activities. Dr. Leppert has a non-compensated relationship as a Early Career Editorial Board with Journal of the American Heart Association that is relevant to AAN interests or activities. Dr. Leppert has a non-compensated relationship as a Neurohospitalist Section Editor with Stroke that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sharon Poisson, MD (University of Colorado Denver)	The institution of Dr. Poisson has received research support from Biogen.
	No disclosure on file

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