黎巴嫩一家三级医疗中心急诊科疑似中风病例的发生率。

The Incidence of Stroke Mimics in the Emergency Department of a Tertiary-care Center in Lebanon.

作者信息

Anan Hind, Bizri Maya, Jomaa Mustapha, Ibrahim Nour, Mufarrij Afif

机构信息

American University of Beirut Medical Center, Department of Emergency Medicine, Beirut, Lebanon.

Cleveland Clinic Foundation, Neurologic Institute, Department of Psychiatry and Psychology, Cleveland, Ohio.

出版信息

West J Emerg Med. 2025 Jul 18;26(4):943-950. doi: 10.5811/westjem.39718.

DOI:10.5811/westjem.39718

PMID:40795014

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12342410/

Abstract

INTRODUCTION

Stroke mimics comprise a significant proportion of cases presenting with neurological deficits and can be difficult to differentiate from true stroke cases. Our aim in this study was to assess the frequency and etiologies of stroke mimics presenting to our emergency department (ED).

METHODS

We conducted a retrospective review of the charts of patients presenting to the ED of a tertiary-care center between November 2018-August 2023 and on whom the stroke code was activated. The cases were categorized into real strokes or stroke mimics based on patients' discharge diagnoses.

RESULTS

Stroke code activation was implemented on 584 patients during the study period. These patients received full service and a final discharge diagnosis. Of these, 349 (59.8%) received a diagnosis of a true stroke, whether ischemic, hemorrhagic, or transient ischemic attack. The remaining 235 (40.2%) were classified as stroke mimics, with functional (12.8%) and medical (87.2%) etiologies. Medical stroke mimics were further categorized into non-cerebrovascular neurologic (59.5%), infection or allergic reaction (17.1%), cardiovascular (11.7%), metabolic or drug-induced (8.3%), and other (3.4%). Factors found to favor stroke mimics were history of neurological (adjusted odds ratio [aOR] 4.98; 95% confidence interval [CI] 2.89 - 8.57) or psychiatric disorders (aOR 2.88; 95% CI 1.29 - 6.41) and patients presenting with altered mental status (aOR 1.70; 95% CI 1.04 - 2.80) or generalized weakness (aOR 2.38; 95% CI1.12 - 5.03). Conversely, factors that favored true strokes (with OR <1 for mimics), were patients aged >65 years (aOR 0.61; 95% CI 0.38-0.96), history of hypertension (aOR 0.61; 95% CI 0.38 - 0.97) or atrial fibrillation (aOR 0.39; 95% CI 0.21 - 0.72), and presenting with speech disturbance (aOR 0.56; 95% CI 0.37-0.83) or extremity weakness (aOR: 0.22; 95% CI 0.15-0.38).

CONCLUSION

Approximately 40% of cases presenting to our ED with stroke code activation were found to be mimics. The high ratio warrants the establishment and adoption of a more specific triaging algorithm for stroke code activation to minimize the pressure on an already overburdened healthcare sector.

摘要

引言

类卒中病例在表现出神经功能缺损的病例中占相当大的比例，并且可能难以与真正的卒中病例区分开来。我们这项研究的目的是评估到我们急诊科就诊的类卒中病例的发生率和病因。

方法

我们对2018年11月至2023年8月期间在一家三级医疗中心急诊科就诊且启动了卒中代码的患者病历进行了回顾性研究。根据患者的出院诊断，将这些病例分为真正的卒中和类卒中。

结果

在研究期间，对584例患者实施了卒中代码激活。这些患者接受了全面的诊疗服务并得到了最终的出院诊断。其中，349例（59.8%）被诊断为真正的卒中，无论是缺血性、出血性还是短暂性脑缺血发作。其余235例（40.2%）被归类为类卒中，病因包括功能性（12.8%）和内科性（87.2%）。内科性类卒中进一步分为非脑血管性神经疾病（59.5%）、感染或过敏反应（17.1%）、心血管疾病（11.7%）、代谢或药物性（8.3%）以及其他（3.4%）。发现有利于类卒中诊断的因素包括有神经疾病史（调整优势比[aOR]4.98；95%置信区间[CI]2.89 - 8.57）或精神疾病史（aOR 2.88；95% CI 1.29 - 6.41），以及表现为精神状态改变（aOR 1.70；95% CI 1.04 - 2.80）或全身无力（aOR 2.38；95% CI 1.12 - 5.03）的患者。相反，有利于真正卒中诊断的因素（类卒中的OR<1）包括年龄>65岁的患者（aOR 0.61；95% CI 0.38 - 0.96）、有高血压病史（aOR 0.61；95% CI 0.38 - 0.97）或心房颤动病史（aOR 0.39；95% CI 0.21 - 0.72），以及表现为言语障碍（aOR 0.56；95% CI 0.37 - 0.83）或肢体无力（aOR：0.22；95% CI 0.15 - 0.38）的患者。