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Telestroke consultation can accurately diagnose ischemic stroke mimics
Jason T Poon1, Aleksander Tkach1, Adam H de Havenon1,2
1Department of Neurology, University of Utah, USA.
Journal of Telemedicine and Telecare
|February 4, 2021
Summary
Telestroke networks accurately diagnose acute ischemic stroke (AIS) and stroke mimics. This study confirms telestroke systems reliably differentiate between AIS and stroke mimics, improving patient care.
Area of Science:
- Neurology
- Telemedicine
- Medical Diagnostics
Background:
- Telestroke (TS) networks are widely implemented in the US.
- Existing TS systems have an approximate 33% rate of diagnosing stroke mimics.
- The diagnostic accuracy of TS for differentiating acute ischemic stroke (AIS) from stroke mimics remains unclear.
Purpose of the Study:
- To evaluate the diagnostic accuracy of telestroke consultations in distinguishing between acute ischemic stroke (AIS) and stroke mimics.
- To compare telestroke diagnoses with final discharge diagnoses for accuracy.
Main Methods:
- Retrospective review of 404 consecutive telestroke consults across 27 sites in six states (2018).
- Comparison of telestroke diagnoses with verified discharge diagnoses, excluding intracerebral hemorrhage and unclear cases.
- Analysis of diagnostic agreement and Cohen's kappa for AIS/transient ischemic attack (TIA) versus stroke mimic categories.
Main Results:
- High diagnostic agreement (88%) and excellent kappa (0.75) between telestroke and discharge diagnoses for AIS/TIA versus stroke mimics.
- Telestroke diagnosis of stroke mimic had a positive predictive value (PPV) of 85% and a negative predictive value (NPV) of 90%.
- Telestroke diagnosis of stroke/TIA had a PPV of 90% and an NPV of 85%.
Conclusions:
- Telestroke systems demonstrate excellent correlation with discharge diagnoses for both stroke and stroke mimics.
- These findings suggest telestroke technology can accurately assess a broad spectrum of acute neurological conditions beyond just AIS.
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