Department of Neurology, University of Utah, USA.
Stroke Center, University of Utah, USA.
J Telemed Telecare. 2023 Jul;29(6):444-450. doi: 10.1177/1357633X21989558. Epub 2021 Feb 3.
Telestroke (TS) networks are standard in many areas of the US. Despite TS systems having approximately 33% mimic rates, it is unknown if TS can accurately diagnose patients with acute ischemic stroke (AIS) versus stroke mimics.
We performed a retrospective review of consecutive TS consults to 27 TS sites in six states during 2018. Clinical information and diagnosis were extracted from discharge records and compared to those from the TS consult. Discharge diagnoses were verified and coded into 12 categories. Cases without a clear discharge diagnosis and intracerebral haemorrhage were excluded. We report agreement and a Cohen's kappa between TS and discharge diagnoses for the category of AIS/transient ischemic attack (TIA) versus stroke mimic.
We included 404 cases in the analysis (mean age 66 years; 54% women). Of these, 225 had a TS diagnosis of AIS/TIA; 102 (45%) received intravenous tissue plasminogen activator. Our study demonstrated a high diagnostic agreement for AIS/TIA (88%) with a kappa of 0.75 for stroke and mimics. Of the 179 patients diagnosed with a stroke mimic on TS, 27 (15%) were diagnosed with AIS/TA by discharge. TS mimic diagnosis had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 90%; TS diagnosis of stroke/TIA had PPV 90%, NPV 85%.
We found excellent correlation between TS and discharge diagnoses for patients with both stroke and stroke mimics. This suggests that TS systems can accurately assess a wider variety of patients with acute neurologic syndromes other than AIS.
远程卒中（TS）网络在美国的许多地区已经标准化。尽管 TS 系统的模拟率约为 33%，但尚不清楚 TS 是否能准确诊断急性缺血性卒中（AIS）与卒中模拟患者。
我们对 2018 年六个州的 27 个 TS 站点的连续 TS 咨询进行了回顾性研究。从出院记录中提取临床信息和诊断，并与 TS 咨询进行比较。对出院诊断进行验证并编码为 12 个类别。排除无明确出院诊断和颅内出血的病例。我们报告了 TS 和出院诊断在 AIS/短暂性脑缺血发作（TIA）与卒中模拟这一类别之间的一致性和 Cohen's kappa。
我们纳入了 404 例患者进行分析（平均年龄 66 岁；54%为女性）。其中 225 例 TS 诊断为 AIS/TIA；102 例（45%）接受了静脉组织型纤溶酶原激活剂治疗。我们的研究表明，AIS/TIA 的诊断高度一致（88%），kappa 值为 0.75。在 179 例 TS 诊断为卒中模拟的患者中，27 例（15%）出院诊断为 AIS/TIA。TS 模拟诊断的阳性预测值（PPV）为 85%，阴性预测值（NPV）为 90%；TS 诊断为卒中/TIA 的 PPV 为 90%，NPV 为 85%。
我们发现 TS 与卒中患者和卒中模拟患者的出院诊断之间具有极好的相关性。这表明 TS 系统可以准确评估急性神经综合征患者，而不仅仅是 AIS。
