Pre-Hospital Diagnosis in Mobile Stroke Unit |
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| Authors: | Ramnath Santosh Ramanathan Dolora Wisco Daniel Vela-Duarte Atif Zafar Ather Taqui Stacey Winners A Blake Buletko Fredrick Hustey Andrew Reimer Andrew Russman Ken Uchino M Shazam Hussain |
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| Institution: | 2. Critical Care Transport, Cleveland Clinic, United States;3. Emergency Services Institute, Cleveland Clinic, United States;2. Department of Cardiology, National University Heart Centre Singapore, Singapore;3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;4. Internal Medicine Residency, National University Health System, Singapore;5. Division of Neurology, Department of Medicine, National University Hospital, Singapore;2. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy;3. Laboratory of Clinical Pathology and Toxicology, Department of Laboratory Medicine, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy;4. Neuroradiology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy;5. Stroke Unit, Department of Neurology, Hospital Vall d''Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain;2. School of Medicine, New York Medical College, Valhalla, NY, USA;2. Neurology, California Hospital Medical Center, Los Angeles, CA USA;3. Pharmacy Services, Adventist Health White Memorial, Los Angeles, CA USA;2. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;3. Department of Radiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan |
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| Abstract: | ObjectivesMobile stroke unit (MSU) has been shown to rapidly provide pre-hospital thrombolysis in acute ischemic stroke (AIS). MSU encounters neurological disorders other than AIS that require emergent treatment.Methods/MaterialsWe obtained pre-hospital diagnosis and treatment data from the prospectively collected dataset on 221 consecutive MSU encounters. Based on initial clinical evaluation and neuroimaging obtained on MSU, the diagnosis of AIS (definite, probable, and possible AIS, transient ischemic attack), intracranial hemorrhage, and likely stroke mimics was made.ResultsFrom July 2014 to April 2015, 221 patients were treated on MSU. 78 (35%) patients had initial clinical diagnosis of definite/probable AIS or TIA, 69 (31%) were diagnosed as possible AIS or TIA, 15 (7%) had intracranial hemorrhage while 59 patients (27%) were diagnosed as likely stroke mimics. Stroke mimics encountered included 13 (6%) metabolic encephalopathy, 11 (5%) seizures, 9 (4%) migraines, 3 (1%) substance abuse, 2 (1%) CNS tumor, 3 (1%) infectious etiology and 3 (1%) hypoglycemia. Fifty-four (24%) patients received non-thrombolytic treatments on MSUConclusionAbout one third of MSU encounters were not AIS initially, including intracranial hemorrhage and stroke mimics. MSU can be utilized to provide pre-hospital treatments in emergent neurological conditions other than AIS. |
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