J Korean Soc Emerg Med.  2018 Oct;29(5):437-448. 10.0000/jksem.2018.29.5.437.

Clinical features and risk factors for missed stroke team activation in cases of acute ischemic stroke in the emergency department

• Byun YH
• Hong SY
• Woo SH
• Kim HJ
• Jeong SK

• KMID: 2435468
• DOI: http://doi.org/10.0000/jksem.2018.29.5.437

Abstract

OBJECTIVE
Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis.
METHODS
We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated.
RESULTS
The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness.
CONCLUSION
A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.

Keyword

Acute ischemic stroke; Stroke team; Missed activation

MeSH Terms

Cerebellum
Consciousness
Diagnosis
Dizziness
Education
Emergencies*
Emergency Service, Hospital*
Gait
Humans
Hypertension
Incidence
National Institutes of Health (U.S.)
Neurologic Examination
Reperfusion
Retrospective Studies
Risk Factors*
Stroke*