Abstract 2354: Prospective Determination of %NODS (Not consistent with Organic Deficit of Stroke) Likelihood with Resultant rt-PA Safety and Functional Outcome
Objective: To assess safety and functional outcomes of rt-PA patients prospectively assigned a high %NODS score. NODS include mimics, functional overlay and complex presentations of mild symptoms. Background: Evidence exists that mimics may be safe to treat but the act of giving rt-PA often results in a stroke diagnosis. Additionally, patients with ICH are unlikely to be coded as non-strokes. Attempts to assess mimics are usually done retrospectively, however after treatment there is often uncertainty in classification of patients as ‘NODS’ or ‘True Stroke.’ Prospective designations of such may not be recorded. To our knowledge, this is the first outcome study for patients prospectively labeled with a high %NODS score prior to rt-PA treatment.
Methods: We reviewed the UCSD SPOTRIAS database, (8/09-Present) for patients prospectively defined as NODS (% likelihood that deficits are Not consistent with Organic Deficits of Stroke) ≥75% and NODS≥50%. Baseline characteristics, safety (SxICH), and outcome (90-day mRS(0-2)) were compared to ‘True Strokes’ (NODS≤25%). Continuous variables were compared using Wilcoxon-Rank Sum. Categorical variables were compared with Fisher's Exact.
Results: There were 114 'True Strokes', 7 NODS≥75%, and 12 NODS≥50%. Mean age was 70.7, 51.9 (p=0.0064) and 51.1 years (p<0.001) respectively. Pre-stroke mRS(0-2) was 85.1%, 100% (p=0.59) and 91.7% (p>0.999). Baseline NIHSS was 11.5, 7.7 (p=0.36) and 6.6 (p=0.08). Outcomes were adjusted for baseline mRS. Home d/c was 40.95%, 71.4% and 66.7%. 90-day mRS(0-2) was 50%, 66.7% and 70%. Ambulance use was 85.1%, 57.1% and 58.3%. SxICH was 6.2%, 0%, 0%. Timelines were similar except for “Onset to Arrival” (74min, 42min, 61min), and “CT to decision” (22min, 43min, 38min).
Conclusions: Small numbers precluded statistical significance, but absolute numbers were of clinical interest. NODS patients were younger, had less prior deficit, had milder strokes, activated EMS less frequently (possibly due to mild or less “real” deficit), had better 90-day mRS, less ICH, shorter 'onset-arrival' (perhaps arriving earlier due to improved recognition, increased fear of true or perceived deficit, or even EMS issues) but longer 'CT-decision' (perhaps requiring more time to consider pros and cons of rt-PA therapy). This intriguing exploratory analysis serves to generate hypotheses for our subsequent larger studies. If verified, high %NODS score patients may be considered safe for rt-PA therapy.
- © 2012 by American Heart Association, Inc.