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.edu+2View all authors and affiliations

Volume 13, Issue 2

https://doi.org/10.1177/19418744221144343

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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.