Introduction. Our aim was to compare the structure and management of conditions mimicking acute cerebrovascular events (ACE) defined as stroke or transient ischaemic attack between patients referred directly to a neurological emergency department (ED) by non-ambulance physicians, ambulance physicians and paramedics. Methods. This is a retrospective study of 802 consecutive patients referred to a Polish urban neurological ED with a prehospital suspicion of ACE between January and December 2014. Results. After proper neurological assessment, ACE was excluded in 258 (32.2%) patients. The ratios of neurological to non-neurological ACE mimics were similar across all groups (35:93 for non-ambulance physicians, 22:39 for ambulance physicians, and 28:39 for paramedics). The most frequent conditions mimicking ACE were vertigo (14.0%), headache (9.7%), seizures (7.0%), blood hypertension (7.0%), electrolyte and metabolic disturbances (5.4%), infections (4.7%) and syncope (4.3%). There were no major differences between patients with ACE-mimics referred by ambulance physicians and referred by paramedics in terms of demographic, previous medical history, extent of diagnostic workup, final diagnosis or further management (neurological admission in 42.6% and 28.4% of cases). However, the characteristics and management of ACE mimics referred by non-ambulance physicians were slightly different, including a lower need for hospital admission (neurological admission in 21.5% of cases). Conclusions. There seem to be no major differences in the structure, early diagnostic approach or management of ACE mimics between referrals from ambulance physicians and ambulance paramedics, which provides reassurance to healthcare systems that rely solely on paramedics. Mimics referred by non-ambulance physicians appear different in structure and are less resource-consuming.

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Introduction.Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED).Material and methods. This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. Results.Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians.Conclusions. Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.