Dawson Ang, Cloud Geoffrey C, Pereira Anthony C, Moynihan Barry J
St. George's University Hospitals NHS Foundation Trust, London, UK.
St. George's University Hospitals NHS Foundation Trust, London, UK
Clin Med (Lond). 2016 Oct;16(5):423-426. doi: 10.7861/clinmedicine.16-5-423.
Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered.
近年来，一些国家的卒中服务已实现集中化。诊断急性卒中具有挑战性，入住卒中单元的患者中有很大一部分被诊断为非卒中疾病（类卒中）。本研究旨在描述类卒中患者群体，包括他们对卒中服务的影响。我们分析了伦敦圣乔治医院卒中单元连续收治的2305例患者的常规临床数据。类卒中分组由335个单独代码归纳为17个分组。在2305例入院患者中，确定了555例类卒中诊断（24.2%），72%的类卒中患者至少有一项卒中危险因素。常见的类卒中诊断为头痛、癫痫发作和晕厥。医学上无法解释的症状和基础疾病的失代偿也很常见。中位住院时间为1天；痴呆诊断（p = 0.028）或需要进行磁共振成像（MRI）检查（p = 0.006）与住院时间延长有关。尽管经过专科临床医生在急诊科的评估以及脑部计算机断层扫描，但每四名入院的疑似卒中患者中仍有一人被诊断为非卒中。类卒中代表了一个异质性患者群体，对卒中服务有重大影响。在考虑服务重组时，卒中与急性神经科服务的同地设置可能具有优势。
