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. 2022 Aug 18:13:939618.
doi: 10.3389/fneur.2022.939618. eCollection 2022.

Prehospital stroke mimics in the Stockholm Stroke Triage System

Mimmi Sjöö  1 , Annika Berglund  1   2 , Christina Sjöstrand  1   3 , Einar E Eriksson  1   2 , Michael V Mazya  1   2
Affiliations

Prehospital stroke mimics in the Stockholm Stroke Triage System

Mimmi Sjöö et al. Front Neurol. .

Abstract

Introduction: In 2017, Stockholm implemented a new prehospital stroke triage system (SSTS) directing patients with a likely indication for thrombectomy to the regional comprehensive stroke center (CSC) based on symptom severity and teleconsultation with a physician. In Stockholm, 44% of patients with prehospital code stroke have stroke mimics. Inadvertent triage of stroke mimics to the CSC could lead to inappropriate resource utilization.

Aims: To compare the characteristics between (1) triage-positive stroke mimics and stroke (TP mimics and TP stroke) and (2) triage-negative stroke mimics and stroke (TN mimics and TN stroke) and to (3) compare the distribution of stroke mimic diagnoses between triage-positive and triage-negative cases.

Methods: This prospective observational study collected data from October 2017 to October 2018, including 2,905 patients with suspected stroke who were transported by code-stroke ambulance to a Stockholm regional hospital. Patients directed to the CSC were defined as triage-positive. Those directed to the nearest stroke center were defined as triage-negative.

Results: Compared to individuals with TP stroke (n = 268), those with TP mimics (n = 55, median 64 vs. 75 years, P < 0.001) were younger and had lower NIHSS score (median 7 vs. 15, P < 0.001). Similarly, those with TN mimics (n = 1,221) were younger than those with TN stroke (n = 1,361, median 73 vs. 78 years, P < 0.001) and had lower NIHSS scores (median 2 vs. 4, P < 0.001). Functional paresis was more common in those with TP mimics than in those with TN mimics, 18/55 (32.7%) vs. 82/1,221 (6.7%), P < 0.001. Systemic infection was less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 160/1,221 (13.1%), P < 0.011. There was a trend toward "syncope, hypotension, or other cardiovascular diagnosis" being less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 118/1,221 (9.7%), P < 0.055.

Conclusions: In the SSTS, those with triage-positive and triage-negative stroke mimics were younger and had less severe symptoms than patients with stroke. All patients with TP mimics who had hemiparesis but overall exhibited less severe symptoms against true stroke but more severe symptoms than those with TN mimics were triaged to the nearest hospital. Over-triage of functional paresis to the CSC was relatively common. Meanwhile, a large majority of cases with minor symptoms caused by stroke mimics was triaged correctly by the SSTS to the nearest stroke center.

Keywords: acute ischemic stroke; prehospital triage; stroke mimics; telemedicine; thrombectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the Stockholm Stroke Triage System.
Figure 2
Figure 2
Patient distribution per study group.
See this image and copyright information in PMC

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References

    1. Meretoja A, Keshtkaran M, Saver JL, Tatlisumak T, Parsons MW, Kaste M, et al. . Stroke thrombolysis: save a minute, save a day. Stroke. (2014) 45:1053–8. 10.1161/STROKEAHA.113.002910 - DOI - PubMed
    1. Meretoja A, Keshtkaran M, Tatlisumak T, Donnan GA, Churilov L. Endovascular therapy for ischemic stroke: save a minute-save a week. Neurology. (2017) 88:2123–7. 10.1212/WNL.0000000000003981 - DOI - PubMed
    1. Froehler MT, Saver JL, Zaidat OO, Jahan R, Aziz-Sultan MA, Klucznik RP, et al. . Interhospital transfer before thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry (systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke). Circulation. (2017) 136:2311–21. 10.1161/CIRCULATIONAHA.117.028920 - DOI - PMC - PubMed
    1. Berglund A, Svensson L, Sjöstrand C, von Arbin M, von Euler M, Wahlgren N, et al. . Higher prehospital priority level of stroke improves thrombolysis frequency and time to stroke unit: the Hyper Acute STroke Alarm (HASTA) study. Stroke. (2012) 43:2666–70. 10.1161/STROKEAHA.112.652644 - DOI - PubMed
    1. Mazya MV, Berglund A, Ahmed N, von Euler M, Holmin S, Laska AC, et al. . Implementation of a prehospital stroke triage system using symptom severity and teleconsultation in the stockholm stroke triage study. JAMA Neurol. (2020) 77:691–9. 10.1001/jamaneurol.2020.0319 - DOI - PMC - PubMed

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