CONDITIONS THAT MIMIC STROKE IN THE EMERGENCY DEPARTMENT - IMPLICATIONS FOR ACUTE STROKE TRIALS
CONDITIONS THAT MIMIC STROKE IN THE EMERGENCY DEPARTMENT - IMPLICATIONS FOR ACUTE STROKE TRIALS
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DOI：
10.1001/archneur.1995.00540350113023
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发表时间：
1995-11-01
影响因子：
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通讯作者：
RAO, TH
中科院分区：
文献类型：
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作者：
LIBMAN, RB;WIRKOWSKI, E;RAO, TH
目的：确定是否有任何临床变量可以早期区分卒中和其他表现为卒中样的疾病。背景：治疗急性缺血性卒中的新疗法正在积极研究中。这些治疗中的许多都有潜在的不良影响。众所周知，非脑血管疾病可以表现为类似于中风的临床表现，因此早期准确地将这种“模仿”与真正的中风区分开来是至关重要的。方法：对1990年1月至1992年1月期间来急诊科就诊的连续患者进行评估。回顾图表可以将这些患者分为两个最终诊断组：模拟中风和真正中风。用Logistic回归分析评估初始评估时测量的预测变量对最终诊断的影响。结果：共有411名患者初步诊断为中风。在这些患者中，78名患者(19%)最终被发现患有模拟症，大多数患者包括死亡后状态、全身感染、肿瘤和毒性代谢障碍。单因素分析显示，意识水平降低和眼球运动正常增加了模仿的几率，而视野异常、舒张压>90 mm Hg、心电图房颤和心绞痛史则降低了模仿的几率。多因素分析显示意识减退增加，而心绞痛病史减少，模仿的几率增加。该模型预测中风的敏感性仅为21%，而特异性为96%。结论：对于面临是否将可能的中风患者随机分成急性治疗方案的神经科医生来说，这些发现有一定的用处，但需要在急诊科对模拟中风的情况进行进一步研究。
Objective: To determine if any clinical variables allow early discrimination between stroke and other conditions presenting with a strokelike picture.Background: New therapeutic modalities for the treatment of acute ischemic stroke are under active investigation. Many of these treatments have potential adverse effects. It is well known that noncerebrovascular conditions can present with a clinical picture mimicking stroke, so early accurate differentiation of such ''mimics'' from true stroke is essential.Methods: Consecutive patients who presented to the emergency department with an initial diagnosis of stroke between January 1990 and January 1992 were evaluated. Chart review allowed these patients to be classified into two final diagnostic groups: stroke mimic and true stroke. Logistic regression was used to estimate the effects of predictor variables measured at initial evaluation on the final diagnosis.Results: There were 411 patients initially diagnosed as having stroke. Of these, 78 patients (19%) were eventually found to have mimics, the majority comprising postictal states, systemic infections, tumors, and toxic-metabolic disturbances. Univariate analysis showed that decreased level of consciousness and normal eye movements increased the odds of mimic, while abnormal visual fields, diastolic blood pressure greater than 90 mm Hg, atrial fibrillation on electrocardiogram, and history of angina decreased the odds of mimic. Multivariate analysis showed that decreased consciousness increased, while history of angina decreased, the odds of mimic. Sensitivity of this model for predicting mimics was only 21% while specificity was 96%.Conclusion: For the neurologist faced with an immediate decision as to whether to randomize a patient with probable stroke to an acute treatment protocol, these findings have some usefulness but mandate further research into conditions that mimic stroke in the emergency department.