081 Description of a stroke unit mimic admissions. Issue 6 (24th May 2018)

• Record Type: Journal Article
• Authors: Cashion, Catelyn; Gawarikar, Yash; Patel, Ronak
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 89:Issue 6(2018)
• Page Start: A33
• Page End: A33
• Publication Date: 2018-05-24
• Subjects: Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2018-ANZAN.80
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Introduction: There is evidence to support both clinically and economically that stroke units improve stroke outcomes, but this is offset by high stroke mimics rates, which account for up to quarter of stroke unit admissions. There is no Australian data looking at stroke mimic rates and the time of day when they are admitted. Methods: We conducted a retrospective cross-sectional study at Calvary Public Hospital, Bruce from May 2014 to May 2017 looking at stroke unit admission rates and mimic types. We collected data on the times of stroke unit admission, business hours Monday to Friday 0800–1630 hours and after-hours Monday to Friday 1630–0800 hours, weekends 0800–0800 hours. Stroke mimics length of stay (LOS) was compared with TIA mild strokes (NIHSS <5) LOS. Results: Out of 1017 stoke unit admissions, 257 (25.3%) were stroke mimics. The most common mimic diagnoses were migraine and headaches (18.3%), peripheral vestibulopathy (14.0%), and functional neurology (13.2%). Data on admission times were available for 240 of 257 (93.4%) mimics of which more than 2/3 s of mimics were admitted after-hours; Bayes factor 0.912 demonstrating this is unlikely to be a significant difference. 3.5% of stroke mimics were thrombolysed with 2/3 s occurring after-hours. The average LOS was 2.3 days for mimics, compared to 4.0 days for TIA and minor strokes (p=0.00017). Conclusion: Our study shows similar stroke mimic rates as previously described in literature with a higher proportion of these patients were admitted after-hours. However, there is little evidence that this difference is significant. The LOS for stroke mimics was less than TIAs and minor strokes. Our study highlights the need for better recognition of stroke mimics in order to prevent unnecessary utilisation of a valuable resource such as the stroke unit.