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Methods for Acute and Subacute Murine Hindlimb Ischemia
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Methods for Acute and Subacute Murine Hindlimb Ischemia

Published on: June 21, 2016

Stroke mimics under the drip-and-ship paradigm.

Sonal Mehta1, Nirav Vora2, Randall C Edgell1

  • 1Department of Neurology and Psychiatry, St Louis University Hospital, St Louis, Missouri.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|August 20, 2013
PubMed
Summary

The drip-and-ship paradigm for acute ischemic stroke (AIS) treatment may lead to better outcomes due to a higher rate of stroke mimics (SM). Patients with psychiatric history are more likely to be diagnosed with SM in this model.

Keywords:
Strokeacute ischemic strokeconversion disorderdrip-and-shipstroke mimicstPAthrombolysis

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Stroke Care

Background:

  • The drip-and-ship paradigm for acute ischemic stroke (AIS) treatment has been associated with improved patient outcomes.
  • This study investigates the hypothesis that a higher prevalence of stroke mimics (SM) in patients transferred from non-specialized to comprehensive stroke centers contributes to these better outcomes.

Purpose of the Study:

  • To determine the rate of stroke mimics (SM) in patients undergoing thrombolysis for AIS.
  • To identify predictors of SM, particularly in relation to the drip-and-ship treatment paradigm.
  • To compare outcomes of SM versus confirmed AIS in the context of different treatment pathways.

Main Methods:

  • Retrospective review of consecutive patients treated with thrombolysis for AIS at a single comprehensive stroke center over one academic year.
  • Data collection included demographics, complications, psychiatric diagnoses, and discharge disposition.
  • Comparative and adjusted analyses were performed to identify predictors of SM, with a stratified analysis based on the drip-and-ship status.

Main Results:

  • Of 120 patients, 20 (16.7%) were diagnosed with SM, predominantly conversion syndrome.
  • SM patients were younger and more likely to have psychiatric diagnoses.
  • The drip-and-ship paradigm was a significant predictor of SM (OR 12.8), with 21.7% of these patients diagnosed as SM compared to 5.4% of direct admissions (P=0.02).
  • No SM patients experienced hemorrhagic complications, and all were discharged home.

Conclusions:

  • The drip-and-ship paradigm and a history of psychiatric illness are significant predictors for diagnosing stroke mimics (SM).
  • Stroke mimics treated via the drip-and-ship model had no thrombolysis-related complications and favorable discharge dispositions.
  • These findings suggest that the higher rate of SM in the drip-and-ship model may contribute to the observed superior outcomes in AIS treatment.