Encephalopathy only stroke codes (EoSC) do not result in rt-PA treatments

Area of Science:

• Neurology
• Emergency Medicine
• Stroke Research

Background:

• Isolated mental status changes (EoSC+) are uncommon stroke code triggers, accounting for 0.1-0.2% of all stroke codes.
• These patients require intensive resources similar to other stroke alerts.
• Previous studies have not detailed the characteristics or thrombolytic treatment rates for EoSC+ strokes.

Purpose of the Study:

• To investigate the incidence of stroke/TIA in patients presenting with isolated mental status changes.
• To characterize the patient profiles and risk factors associated with EoSC+ strokes.
• To determine the rate of thrombolytic treatment (rt-PA) in this patient group.

Main Methods:

• Retrospective analysis of stroke codes from 2004-2018.
• Defined EoSC+ based on NIHSS scores for specific items (Q1a, 1b, 1c).
• Compared characteristics and risk factors between EoSC+ and EoSC- patients, and specifically for EoSC+ Stroke+ and rt-PA treated patients.

Main Results:

• EoSC+ occurred in 1.84% of stroke codes; EoSC+ Stroke+ occurred in 0.27% of all codes.
• Patients with EoSC+ had fewer risk factors like hypertension and history of stroke/TIA compared to EoSC-.
• No cases of rt-PA eligibility or treatment were observed in EoSC+ Stroke+ patients; imaging confirmed stroke/hemorrhage in only 0.10% of all stroke codes.

Conclusions:

• EoSC+ rarely progresses to stroke/TIA (0.27%) or confirmed stroke (0.10%).
• Thrombolytic therapy (rt-PA) was never administered to EoSC+ Stroke+ patients in this cohort.
• Understanding these characteristics can aid in the efficient triage of stroke resources for patients with isolated mental status changes.