Abstract 91: Prehospital Blood Pressure Differentiates Acute Stroke From Mimics
Introduction: Elevated hospital admission blood pressure (BP) in acute stroke is common and associated with poor outcomes. The natural history of BP in suspected stroke patients in the prehospital setting is unknown. We tested the hypothesis that prehospital BP values are higher in acute stroke patients, relative to stroke mimics.
Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP measurements, of all patients transported by Emergency Medical Services (EMS) to the Emergency Department (ED) of a single hospital with acute stroke symptoms during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging review were utilized to determine final diagnosis of ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage (ICH) or stroke mimic. BP data was analyzed by one-way ANOVA followed by Tukey’s test for independent comparisons.
Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Median (IQR) time from symptom onset to first BP measurement was 70.5 (204) minutes. The final diagnosis was stroke in 524 (59.7%) patients (41.0% ischemic stroke, 11.7% TIA, 7.0% ICH) and 354 (40.4%) were considered mimics. Mean ± SD prehospital SBP was higher in acute stroke patients (155 ± 31 mmHg) compared to stroke mimics (143 ± 32 mmHg), p<0.001). Mean prehospital SBP was higher in ICH (171 ±33 mmHg, p=0.001) than both ischemic stroke (155 ± 27 mmHg) and TIA (153 ± 23 mmHg). SBP remained stable during EMS transport in all patients (median -3 (22) mmHg), p=0.16). Mean prehospital SBP was correlated with ED SBP (R=0.85, p<0.001). Mean SBP at ED arrival was higher in acute stroke patients (ICH: 170 ± 34 mmHg, ischemic stroke: 154 ± 30 mmHg, TIA: 153 ± 26 mmHg) than stroke mimics (142 ± 28 mmHg), p<0.001).
Conclusion: Higher prehospital SBP differentiates acute stroke from stroke mimics. Blood pressures are highest in ICH patients. Prehospital BP remains stable until ED arrival. Elevated prehospital BP may help identify patients with acute stroke. Acute BP elevation may also represent an acute prehospital treatment target.
Author Disclosures: L.C. Gioia: Other Research Support; Significant; AIHS Clinical Fellowship Bursary. R.T. Zewude: None. M.P. Kate: Other Research Support; Significant; AIHS Clinical Fellowship Bursary. K. Liss: None. B.H. Rowe: None. K. Butcher: None.
- © 2015 by American Heart Association, Inc.