J Korean Med Sci.  2022 Feb;37(7):e54. 10.3346/jkms.2022.37.e54.

Clinical Differences Between Stroke and Stroke Mimics in Code Stroke Patients

• Kim T
• Jeong HY
• Suh GJ

• KMID: 2526517
• DOI: http://doi.org/10.3346/jkms.2022.37.e54

Abstract

Background
The code stroke system is designed to identify stroke patients who may benefit from reperfusion therapy. It is essential for emergency physicians to rapidly distinguish true strokes from stroke mimics to activate code stroke. This study aimed to investigate the clinical and neurological characteristics that can be used to differentiate between stroke and stroke mimics in the emergency department (ED).
Methods
We conducted a retrospective observational study of code stroke patients in the ED from January to December 2019. The baseline characteristics and the clinical and neurological features of stroke mimics were compared with those of strokes.
Results
A total of 409 code stroke patients presented to the ED, and 125 (31%) were diagnosed with stroke mimics. The common stroke mimics were seizures (21.7%), drug toxicity (12.0%), metabolic disorders (11.2%), brain tumors (8.8%), and peripheral vertigo (7.2%). The independent predictors of stroke mimics were psychiatric disorders, dizziness, altered mental status, and seizure-like movements, while current smoking, elevated systolic blood pressure, atrial fibrillation on the initial electrocardiogram, hemiparesis as a symptom, and facial palsy as a sign suggested a stroke. In addition, the likelihood of a stroke in code stroke patients tended to increase as the number of accompanying deficits increased from the following set of seven focal neurological deficits: hemiparesis (or upper limb monoparesis), unilateral limb sensory change, facial palsy, dysarthria, aphasia (or neglect), visual field defect, and oculomotor disorder (P < 0.001).
Conclusion
Some clinical and neurological characteristics have been identified to help differentiate stroke mimics from true stroke. In particular, the likelihood of stroke tended to increase as the number of accompanying focal neurological deficits increased.

Keyword

Stroke Mimics; Stroke; Code Stroke; Emergency Department

Figure

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  Fig. 1 Flowchart of the code stroke cases.TIA = transient ischemic attack.

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  Fig. 2 Multivariate logistic regression analysis for prediction of stroke in code stroke patients.OR = odds ratio, CI = confidence interval, ECG = electrocardiogram, BP = blood pressure.aVariables derived from predictive factors with a significant (P < 0.05) in the univariate analysis and multivariate analysis for stroke prediction.bThe total number of neurological deficits observed in the patients among the following seven specific neurological deficits: hemiparesis (or upper limb monoparesis), unilateral limb sensory change, facial palsy, dysarthria, aphasia (or neglect), eye movement disorder, and visual field defect.cDue to the number of patients was small when there were 5 to 7 focal neurological deficits, these categories were included as a single category with numbers of focal neurologica deficits ≥ 5.

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  Fig. 3 ROC curve of the multivariate logistic regression model. (A) ROC curve analysis and AUC calculation for prediction of stroke in code stroke patients. (B) ROC curve analysis and AUC calculation for prediction of stroke mimics in code stroke patients.ROC = receiver operating characteristic, AUC = area under the curve.

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