InHospital strokes (IHS) account for 417% of all ischemic strokes and are associated with increased morbidity and mortality compared to strokes with onset in the community. As with all strokes, early identification of IHS is of utmost importance. However, stroke syndromes are diverse and many patients in the hospital setting have comorbid illness, medication side effects, and delirium that may induce symptoms mimicking strokes. The similarities of symptoms often lead to unnecessary alerts or missed strokes. The objectives of the study were to identify characteristics, risk factors, and presenting symptoms of both stoke mimics and true strokes in hospitalized patients.
Retrospective chart review of all of the inhospital stokes alerts at the University of Colorado. Data were obtained on demographics, comorbidities, IHS presenting symptoms, diagnosis, hospital care and discharge location. The Colorado Institutional Review Board approved this study.
Inhospital strokes alerts accounted for 64 of 402 (15.9%) strokes alerts from 1/1/2009 to 9/30/2009. The mean patient age for inhospital stroke alerts was 58.4 years old. On the average, alerts were called on the seventh day of hospitalization. Of the 64 inhospital stroke alerts, 22.7% had a documented ischemic stroke, 15.2% had a TIA, 15.2% had symptoms of metabolic derangement, 19.7% were due to medication, and 27.3% were due to sepsis or delirium. 33.3% of IHS occurred in a perioperative period versus 27.5% of stroke mimics. IHS presented with speech disturbance in 46.7%, gaze changes in 46.7%, and focal weakness in 40%. A change in mental status occurred in 27.5% of IHS. Stroke mimics had speech disturbance in 35.9%, gaze changes in 7.8%, focal weakness in 31.4%, and change in mental status in 47.1%. In no case was altered mental status the lone presentation for true stroke. 40% of IHS patients went to a facility on discharge versus 32.7% of those diagnosed with a stroke mimic.
In this retrospective review, many symptoms of true IHS and stroke mimics were similar, although altered mental status was more often observed in stroke mimics. Alternatively, gaze changes were common and predictive of true stroke. Focal motor deficits and speech changes occur with similar frequency between the two groups. Altered mental status has many potential etiologies in the hospitalized patient and as a sole trigger is likely to increase the rate of false positive stroke alerts. This analysis, if confirmed in larger multicenter studies, suggests key elements of hospital staff educational programs with potential to improve accuracy of inhospital stroke alerts.
To cite this abstract:Cumbler E, Jennings K. Signs of Catastrophe: Characterizing Acute Inhospital Strokes. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97589. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/signs-of-catastrophe-characterizing-acute-inhospital-strokes/. Accessed April 5, 2020.