Hemmen Thomas M, Meyer Brett C, McClean Teri L, Lyden Patrick D
Department of Neuroscience, University of California, San Diego, California,
J Stroke Cerebrovasc Dis. 2008 Jan-Feb;17(1):23-5. doi: 10.1016/j.jstrokecerebrovasdis.2007.09.008.
Code Stroke systems are widely used to expedite emergency treatment of patients with stroke. Code Stroke for mimic patients-those without a stroke cause-wastes resources. We investigated how many times a Code Stroke was initiated for patients who did not have a stroke appropriate for thrombolysis.
We conducted a retrospective review of the discharge diagnoses of all patients who presented to our emergency department as a Code Stroke. A patient was considered a stroke mimic if a stroke code was activated, but none of the first 3 International Classification of Diseases, Ninth Revision codes on discharge were transient ischemic attack-related or ischemic stroke-related.
A total of 411 patients presented to the emergency department as Code Stroke. In all, 104 (25.3%) were discharged without a diagnosis of stroke or transient ischemic attack. The diagnoses in this group were intracranial hemorrhage in 19 patients, subarachnoid hemorrhage 6, subdural hematoma 3, old deficit 11, hypotension 11, seizure 10, intoxication 8, hypoglycemia 7, mass lesion 6, migraine 5, and other 18. In all, 33 of 307 eligible patients (10.7%) were treated with tissue-type plasminogen activator. None of the patients with a stroke mimic received tissue-type plasminogen activator. In 44 of 104 stroke mimics (42.3%), the acute disease was caused by a severe neurologic condition other than ischemic cerebrovascular disease. Only 60 of 411 stroke codes (14.6%) were initiated for patients without a severe and acute neurologic condition.
In our community, 25.5% of all Code Strokes were initiated for stroke mimics. Most mimic patients had an illness likely to benefit from urgent neurologic evaluation.
卒中急救系统被广泛用于加快卒中患者的急诊治疗。针对假性卒中患者（即无卒中病因的患者）启动卒中急救会造成资源浪费。我们调查了针对不适合溶栓治疗的非卒中患者启动卒中急救的次数。
我们对所有以卒中急救形式就诊于我院急诊科的患者的出院诊断进行了回顾性研究。如果启动了卒中急救代码，但出院时前三个国际疾病分类第九版代码均与短暂性脑缺血发作或缺血性卒中无关，则该患者被视为假性卒中。
共有411例患者以卒中急救形式就诊于急诊科。其中，104例（25.3%）出院时未诊断为卒中或短暂性脑缺血发作。该组诊断包括颅内出血19例、蛛网膜下腔出血6例、硬膜下血肿3例、陈旧性缺损11例、低血压11例、癫痫发作10例、中毒8例、低血糖7例、占位性病变6例、偏头痛5例及其他18例。在307例符合条件的患者中，共有33例（10.7%）接受了组织型纤溶酶原激活剂治疗。假性卒中患者均未接受组织型纤溶酶原激活剂治疗。在104例假性卒中患者中，44例（42.3%）的急性疾病由缺血性脑血管病以外的严重神经系统疾病引起。411例卒中急救代码中，仅60例（14.6%）是针对无严重急性神经系统疾病的患者启动的。
在我们的社区中，所有卒中急救中有25.5%是针对假性卒中患者启动的。大多数假性卒中患者的疾病可能受益于紧急神经科评估。
