Stroke and TIA mimics in patients referred to a neurological emergency department by non-ambulance physicians, ambulance physicians and paramedics.

Abstract

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.

Changes in Prehospital Stroke Care and Stroke Mimic Patterns during the COVID-19 Lockdown

“…Nonetheless, the wide confidence intervals suggest that the proportion of correctly identified stroke cases vary greatly between different healthcare systems. For example, two studies in neighbouring Poland, a country with a similar primary care system, showed a resembling PPV and stroke mimic pattern [ 7 , 28 ]. One reason behind the difference in PPV between EMS and outpatient physicians could be a striking number of peripheral vestibulopathies being referred to the ED as stroke mimics by the outpatient physicians (18.0% vs. 0.9% of all stroke mimics, p < 0.001).…”

Stroke mimics: incidence, aetiology, clinical features and treatment

“…The presence of physicians in the ambulance seems to marginally improve the rates of diagnosis of ischaemic stroke. In a study from Poland with 805 patients referred to a neurological hospital, the rates of diagnosis of mimics were 35% for an ambulance with no physicians and 22% with ambulances with physicians [ 36 ]. Activation of “STARS” air transport via helicopter also experienced high rates of stroke mimics being transferred to the stroke centres.…”

Bed regime as a lifesaving factor in spontaneous intracranial hypotension

“…Research shows an incorrect diagnosis in 66.3%. Incorrect diagnoses are mainly made in the pre-hospital setting, but can also happen in the ED, especially if the treating physician is not a neurologist or stroke physician [4]. The clinical hallmark is debilitating postural headache, exacerbated by standing, and relieved in the recumbent position.…”