Acute stroke chameleons in a university hospital Risk factors, circumstances, and outcomes
Acute stroke chameleons in a university hospital Risk factors, circumstances, and outcomes
复制标题
DOI：
10.1212/wnl.0000000000001830
复制
发表时间：
2015-08-11
期刊：
影响因子：
9.9
通讯作者：
Michel, Patrik
中科院分区：
文献类型：
--
作者：
Richoz, Benjamin;Hugli, Olivier;Michel, Patrik
目的：确定到达大学医院急诊科的急性缺血性卒中 (AIS) 变色龙 (AIS-C) 个体的危险因素、情况和结果。方法：我们回顾性回顾了 8.25 年期间前瞻性构建的洛桑急性卒中登记和分析中的所有 AIS 患者。 AIS-C 被定义为未能怀疑中风或错误排除中风诊断。将它们与入院时正确诊断的患者进行比较。结果：2,200 例 AIS 中，有 47 例漏诊（2.1%）。这些 AIS-C 要么是非常轻微的中风，要么是非常严重的中风。多变量分析显示，AIS-C 患者年龄较小（比值比 [OR] 每年 0.98，p < 0.01），卒中前他汀类药物治疗较少（OR 0.29，p = 0.04），入院时舒张压较低（OR 0.98 p = 0.04）。他们表现出较少的眼球偏差（OR 0.21，p = 0.04）和更多的小脑卒中（OR 3.78，p < 0.01）。 AIS-C 被误诊为其他神经系统疾病（42.6% 的病例）或非神经系统疾病（17.0%）、不明原因的意识水平下降（21.3%）以及伴随存在的疾病（19.1%）。 12 个月时，AIS-C 患者的预后较差（调整后 OR 0.21，p < 0.01），死亡率较高（调整后 OR 4.37，p < 0.01）。结论：AIS 在年龄较小、脑血管风险较低的患者中被漏诊，并且可能被其他急性病症掩盖。变色龙患者更常出现较轻的中风或昏迷、局灶性体征和小脑中风较少，并且 12 个月时的残疾和死亡率较高。这些发现可用于提高急诊科的认识，以适当地识别和治疗此类患者。
Objective:To identify risk factors, circumstances, and outcomes for individuals with acute ischemic stroke (AIS) chameleons (AIS-C) arriving in the emergency department of a university hospital.Methods:We retrospectively reviewed all patients with AIS from the prospectively constructed Acute Stroke Registry and Analysis of Lausanne during 8.25 years. AIS-C were defined as a failure to suspect stroke or as incorrect exclusion of stroke diagnosis. They were compared with patients diagnosed correctly at the time of admission.Results:Forty-seven of 2,200 AIS were missed (2.1%). These AIS-C were either very mild or very severe strokes. Multivariate analysis showed a younger age in patients with AIS-C (odds ratio [OR] per year 0.98, p < 0.01), less prestroke statin treatment (OR 0.29, p = 0.04), and lower diastolic admission blood pressure (OR 0.98 p = 0.04). They showed less eye deviation (OR 0.21, p = 0.04) and more cerebellar strokes (OR 3.78, p < 0.01). AIS-C were misdiagnosed as other neurologic (42.6% of cases) or nonneurologic (17.0%) disease, as unexplained decreased level of consciousness (21.3%), and as concomitantly present disease (19.1%). At 12 months, patients with AIS-C had less favorable outcomes (adjusted OR 0.21, p < 0.01) and higher mortality (adjusted OR 4.37, p < 0.01).Conclusions:AIS are missed in patients with younger age with a lower cerebrovascular risk profile and may be masked by other acute conditions. Patients with chameleons present more often with milder strokes or coma, fewer focal signs and cerebellar strokes, and have higher disability and mortality rates at 12 months. These findings may be used to raise awareness in emergency departments to recognize and treat such patients appropriately.