The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network.
BACKGROUND
Up to 30% of acute stroke evaluations are deemed stroke mimics (SM). As telestroke consultation expands across the world, increasing numbers of SM patients are likely being evaluated via Telestroke. We developed a model to prospectively identify ischemic SMs during Telestroke evaluation.


METHODS AND RESULTS
We analyzed 829 consecutive patients from January 2004 to April 2013 in our internal New England-based Partners TeleStroke Network for a derivation cohort, and 332 cases for internal validation. External validation was performed on 226 cases from January 2008 to August 2012 in the Partners National TeleStroke Network. A predictive score was developed using stepwise logistic regression, and its performance was assessed using receiver-operating characteristic (ROC) curve analysis. There were 23% SM in the derivation, 24% in the internal, and 22% in external validation cohorts based on final clinical diagnosis. Compared to those with ischemic cerebrovascular disease (iCVD), SM had lower mean age, fewer vascular risk factors, more frequent prior seizure, and a different profile of presenting symptoms. The TeleStroke Mimic Score (TM-Score) was based on factors independently associated with SM status including age, medical history (atrial fibrillation, hypertension, seizures), facial weakness, and National Institutes of Health Stroke Scale >14. The TM-Score performed well on ROC curve analysis (derivation cohort AUC=0.75, internal validation AUC=0.71, external validation AUC=0.77).


CONCLUSIONS
SMs differ substantially from their iCVD counterparts in their vascular risk profiles and other characteristics. Decision-support tools based on predictive models, such as our TM Score, may help clinicians consider alternate diagnosis and potentially detect SMs during complex, time-critical telestroke evaluations.
['Ali|Syed F|SF|', 'Viswanathan|Anand|A|', 'Singhal|Aneesh B|AB|', 'Rost|Natalia S|NS|', 'Forducey|Pamela G|PG|', 'Davis|Lawrence W|LW|', 'Schindler|Joseph|J|', 'Likosky|William|W|', 'Schlegel|Sherene|S|', 'Solenski|Nina|N|', 'Schwamm|Lee H|LH|', '|||']
D000368:Aged D002545:Brain Ischemia D003661:Decision Support Techniques D005260:Female D006801:Humans D008297:Male D015233:Models, Statistical D011446:Prospective Studies D015203:Reproducibility of Results D020521:Stroke D017216:Telemedicine
telestroke stroke mimics cerebrovascular disease thrombolysis