Deans' stroke musings: Validating Existing Scales for Identification of Acute Stroke in an Inpatient Setting

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, April 4, 2023

Validating Existing Scales for Identification of Acute Stroke in an Inpatient Setting

Don't have a stroke while in the hospital. Has your hospital addressed this problem in the last 6 years?

This was known way back in December 2016; what EXACTLY has your hospital done to solve this?

If they haven't solved this you better not have a stroke while hospitalized for COVID-19.

Diane and Bob had a similar problem within the hospital.

Stroke outcomes can be worse when they occur in hospital, Canadian study finds

December 2016

The latest here:

Validating Existing Scales for Identification of Acute Stroke in an Inpatient Setting

Adriana Sari, MD https://orcid.org/0000-0002-1546-4110, Faddi G. Saleh Velez, MD https://orcid.org/0000-0002-2626-6259, and Shyam Prabhakaran, MD, MS shyam1@neurology.bsd.uchicago.eduView all authors and affiliations

Volume 13, Issue 2

https://doi.org/10.1177/19418744221144343

Abstract

Background and Purpose

A significant proportion of strokes occur while patients are hospitalized for other reasons. Numerous stroke scales have been developed and validated for use in pre-hospital and emergency department settings, and there is growing interest to adapt these scales for use in the inpatient setting. We aimed to validate existing stroke scales for inpatient stroke codes.

Methods

We retrospectively reviewed charts from inpatient stroke code activations at an urban academic medical center from January 2016 through December 2018. Receiver operating characteristic analysis was performed for each specified stroke scale including NIHSS, FAST, BE-FAST, 2CAN, FABS, TeleStroke Mimic, and LAMS. We also used logistic regression to identify independent predictors of stroke and to derive a novel scale.

Results

Of the 958 stroke code activations reviewed, 151 (15.8%) had a final diagnosis of ischemic or hemorrhagic stroke. The area under the curve (AUC) of existing scales varied from .465 (FABS score) to .563 (2CAN score). Four risk factors independently predicted stroke: (1) recent cardiovascular procedure, (2) platelet count less than 50 × 10⁹ per liter, (3) gaze deviation, and (4) presence of unilateral leg weakness. Combining these 4 factors into a new score yielded an AUC of .653 (95% confidence interval [CI] .604-.702).

Conclusion

This study suggests that currently available stroke scales may not be sufficient to differentiate strokes from mimics in the inpatient setting. Our data suggest that novel approaches may be required to help with diagnosis in this unique population.