Abstract TP244: Distinguishing Stroke Mimics From Strokes Prior To Treatment With tPA
Introduction: Up to 25% of patients treated with IV tPA are later found to have stroke mimics. Despite low rates of hemorrhagic transformation in these patients, avoiding exposure to unnecessary risk is desirable. Here, we define baseline demographic and clinical characteristics of strokes vs. stroke mimics that might help distinguish these two populations prior to treatment decisions.
Methods: All patients treated with IV tPA at our tertiary care academic medical center are registered in a prospectively maintained database. Consecutive patients from 1/09 to 6/12 were entered in this study. Demographic, historical, and neuro exam findings (20 variables) from stroke or stroke mimic patients (based on the discharge diagnosis) were examined. Spearman correlations and binary logistic regression were used to determine variables contributing to mimic status. Post-hoc correlations of individual NIHSS items with mimic status were examined.
Results: During this period, 346 patients were treated with IV tPA of which 38 (11%) were stroke mimics. Logistic regression revealed that age (B = -0.61, p < 0.001), history of drug use (B = 1.508, p<0.05), and acute NIHSS facial score (B = -1.12, p< 0.01) significantly predicted mimic status. Sex (B = -1.043, p = .066) and “drip and ship” status (B = 1.04, p = .063) were marginal predictors, whereas history of depression, epilepsy, and number of ED visits in the past 5 years failed to predict mimic status. The logistic regression equation accounted for 39% of the variance in mimic status. Post-hoc Spearman correlations of NIHSS categories with mimic status found that total score (r = -0.16), visual field loss (r = -0.16), gaze deviation (r = -0.21), facial weakness (r = -0.22), dysarthria (r = -0.19), and neglect (r = -0.18) were all variables significantly associated with acute stroke.
Conclusion: Younger age, female gender, history of drug use, and treatment at outlying facility (drip and ship) were associated with stroke mimics. NIHSS categories associated with acute stroke were visual field loss, gaze deviation, facial droop, dysarthria and neglect. Identifying baseline variables that help distinguish mimics may minimize inappropriate treatment with tPA.
- © 2012 by American Heart Association, Inc.