The 2CAN Score.

Area of Science:

• Neurology
• Internal Medicine
• Clinical Diagnostics

Background:

• A significant portion of acute strokes occur in hospitalized patients, often complicating their primary treatment.
• Distinguishing between stroke and various mimics (e.g., seizures, delirium) is challenging for non-neurologists.
• A reliable clinical instrument is needed to aid in the early recognition of inpatient strokes.

Purpose of the Study:

• To derive and validate a clinical scoring system for distinguishing acute stroke from its mimics in hospitalized patients.
• To improve diagnostic accuracy for suspected strokes presenting within a hospital setting.

Main Methods:

• Retrospective review of inpatient stroke alerts at a single academic center (January 2014 - December 2016).
• Data collection included demographics, risk factors, neurological exam findings, vital signs, and laboratory values.
• Multivariate logistic regression was used to derive a weighted scoring system (2CAN score), validated using receiver operating characteristic (ROC) analysis.

Main Results:

• Out of 330 subjects, 35.2% had confirmed stroke, 13.0% had neurological mimics, and 51.8% had non-neurological mimics.
• Four factors independently predicted stroke: clinical deficit score, recent cardiac procedure, atrial fibrillation history, and new patient status (<24h admission).
• The 2CAN score demonstrated excellent discrimination (AUC 0.93 in derivation, 0.88 in validation cohorts); a score ≥2 showed 92.2% sensitivity and 69.6% specificity for stroke.

Conclusions:

• The 2CAN score is a validated tool for recognizing inpatient stroke with high accuracy in a single-center study.
• The score aids non-neurologists in differentiating stroke from mimics, potentially leading to faster diagnosis and treatment.
• Further validation in a prospective, multicenter study is recommended to confirm the generalizability of the 2CAN score.