"Encephalopathy Only Stroke Codes" (EoSC) Rarely Result in Stroke as Final Diagnosis

Area of Science:

• Neurology
• Emergency Medicine
• Health Services Research

Background:

• Stroke codes are critical for rapid intervention but are resource-intensive.
• Isolated encephalopathy presentations can trigger stroke codes, potentially diverting resources from true stroke cases.
• The diagnostic yield of stroke codes for encephalopathy-only presentations requires clarification.

Purpose of the Study:

• To determine the likelihood of "Encephalopathy only Stroke Codes" (EoSC) resulting in a confirmed stroke diagnosis (EoSC CVA+).
• To evaluate the impact of different EoSC definitions on diagnostic yield.
• To inform resource allocation strategies for acute stroke care.

Main Methods:

• Analysis of a prospective stroke code registry (2004-2016) involving 3860 patients.
• Defined EoSC using two criteria based on NIH Stroke Scale (NIHSS) scores, focusing on LOC and motor deficits.
• Assessed final diagnoses as stroke (EoSC CVA+) or non-stroke (EoSC CVA-).

Main Results:

• EoSC represented 1.55% to 2.5% of total stroke codes under different definitions.
• True stroke diagnoses (EoSC CVA+) were rare, occurring in 0.13% to 0.23% of all stroke codes and 8.33% to 9.38% of EoSC cases.
• Diabetes was identified as the strongest predictor of stroke in multivariable analysis.

Conclusions:

• Encephalopathy-only Stroke Codes infrequently result in a confirmed stroke diagnosis.
• Current stroke code activation criteria for isolated encephalopathy may lead to inefficient use of critical stroke center resources.
• Refining stroke code activation protocols could improve resource management and patient care.