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Prehospital assessment of suspected stroke and TIA: An observational study

Journal article
Authors Per-Olof Hansson
M. A. Hagiwara
J. Herlitz
P. Brink
B. W. Sundstrom
Published in Acta Neurologica Scandinavica
Volume 140
Issue 2
Pages 93-99
ISSN 0001-6314
Publication year 2019
Published at Institute of Medicine
Pages 93-99
Language en
Links dx.doi.org/10.1111/ane.13107
Keywords diagnosis, emergency medical services, mortality, stroke, public-education, time, ambulance, risk, Neurosciences & Neurology
Subject categories Neurosciences

Abstract

Background Symptoms related to stroke diverge and may mimic many other conditions. Aims To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). Methods An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. Results Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. Conclusions Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.

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