Distinguishing Between Stroke and Mimic at the Bedside
Top Cited Papers
Open Access
- 1 March 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 37 (3), 769-775
- https://doi.org/10.1161/01.str.0000204041.13466.4c
Abstract
Background and Purpose— The bedside clinical assessment of the patient with suspected stroke has not been well studied. Improving clinical skills may accelerate patient progress through the emergency department. We aimed to determine the frequency and nature of stroke mimics and to identify the key clinical features that distinguish between stroke and mimic at the bedside. Methods— Consecutive presentations to an urban teaching hospital with suspected stroke were recruited. A standard bedside clinical assessment was performed. The final diagnosis was determined by an expert panel, which had access to clinical features, brain imaging, and other tests. Univariate and multivariate analyses determined the bedside features that distinguished stroke from mimic. Results— There were 350 presentations by 336 patients. The final diagnosis was stroke in 241 of 350 (69%) and mimic in 109 (31%). The mimics included 44 events labeled “possible stroke or TIA.” Eight items independently predicted the diagnosis in patients presenting with brain attack: cognitive impairment and abnormal signs in other systems suggested a mimic, an exact time of onset, definite focal symptoms, abnormal vascular findings, presence of neurological signs, being able to lateralize the signs to the left or right side of the brain, and being able to determine a clinical stroke subclassification suggested a stroke. Conclusions— The bedside clinical assessment can be streamlined substantially. This has important implications for teaching less experienced clinicians how to assess the patient with suspected stroke.This publication has 15 references indexed in Scilit:
- A systematic review of barriers to delivery of thrombolysis for acute strokeAge and Ageing, 2004
- The clinical significance of diffusion-weighted MR imaging in infratentorial strokesNeurology, 2004
- A multicentre observational study of presentation and early assessment of acute strokeBMJ, 2002
- Delays in stroke referralsThe Lancet, 1999
- Thrombolysis in StrokeJAMA, 1996
- The Risk of Determining Risk with Multivariable ModelsAnnals of Internal Medicine, 1993
- Classification and natural history of clinically identifiable subtypes of cerebral infarctionThe Lancet, 1991
- THE ROLE OF COMPUTED TOMOGRAPHY BRAIN SCAN IN THE DIAGNOSIS OF ACUTE STROKE IN THE ELDERLYAge and Ageing, 1987
- Validation of admission criteria to a stroke unitJournal of Chronic Diseases, 1980
- Intracranial tumors simulating the presentation of cerebrovascular syndromes: Early detection with cerebral computed tomography (CCT)The American Journal of Medicine, 1977