open access

Vol 53, No 1 (2019)
Research papers
Published online: 2019-01-04
Submitted: 2018-11-06
Accepted: 2018-11-06
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Stroke and TIA mimics in patients referred to a neurological emergency department by non-ambulance physicians, ambulance physicians and paramedics

Dorota Kozera-Strzelińska, Michał Karliński, Grzegorz Rak, Magdalena Wojdacz, Halina Sienkiewicz-Jarosz, Iwona Kurkowska-Jastrzębska
DOI: 10.5603/PJNNS.a2019.0002
·
Pubmed: 30614515
·
Neurol Neurochir Pol 2019;53(1):83-89.

open access

Vol 53, No 1 (2019)
Research papers
Published online: 2019-01-04
Submitted: 2018-11-06
Accepted: 2018-11-06

Abstract

Introduction. Our aim was to compare the structure and management of conditions mimicking acute cerebrovascular events (ACE) defined as stroke or transient ischaemic attack between patients referred directly to a neurological emergency department (ED) by non-ambulance physicians, ambulance physicians and paramedics.

Methods. This is a retrospective study of 802 consecutive patients referred to a Polish urban neurological ED with a prehospital suspicion of ACE between January and December 2014.

Results. After proper neurological assessment, ACE was excluded in 258 (32.2%) patients. The ratios of neurological to non--neurological ACE mimics were similar across all groups (35:93 for non-ambulance physicians, 22:39 for ambulance physicians, and 28:39 for paramedics). The most frequent conditions mimicking ACE were vertigo (14.0%), headache (9.7%), seizures (7.0%), blood hypertension (7.0%), electrolyte and metabolic disturbances (5.4%), infections (4.7%) and syncope (4.3%). There were no major differences between patients with ACE-mimics referred by ambulance physicians and referred by paramedics in terms of demographic, previous medical history, extent of diagnostic workup, final diagnosis or further management (neurological admission in 42.6% and 28.4% of cases). However, the characteristics and management of ACE mimics referred by non-ambulance physicians were slightly different, including a lower need for hospital admission (neurological admission in 21.5% of cases).

Conclusions. There seem to be no major differences in the structure, early diagnostic approach or management of ACE mimics between referrals from ambulance physicians and ambulance paramedics, which provides reassurance to healthcare systems that rely solely on paramedics. Mimics referred by non ambulance physicians appear different in structure and are less resource-consuming.

Abstract

Introduction. Our aim was to compare the structure and management of conditions mimicking acute cerebrovascular events (ACE) defined as stroke or transient ischaemic attack between patients referred directly to a neurological emergency department (ED) by non-ambulance physicians, ambulance physicians and paramedics.

Methods. This is a retrospective study of 802 consecutive patients referred to a Polish urban neurological ED with a prehospital suspicion of ACE between January and December 2014.

Results. After proper neurological assessment, ACE was excluded in 258 (32.2%) patients. The ratios of neurological to non--neurological ACE mimics were similar across all groups (35:93 for non-ambulance physicians, 22:39 for ambulance physicians, and 28:39 for paramedics). The most frequent conditions mimicking ACE were vertigo (14.0%), headache (9.7%), seizures (7.0%), blood hypertension (7.0%), electrolyte and metabolic disturbances (5.4%), infections (4.7%) and syncope (4.3%). There were no major differences between patients with ACE-mimics referred by ambulance physicians and referred by paramedics in terms of demographic, previous medical history, extent of diagnostic workup, final diagnosis or further management (neurological admission in 42.6% and 28.4% of cases). However, the characteristics and management of ACE mimics referred by non-ambulance physicians were slightly different, including a lower need for hospital admission (neurological admission in 21.5% of cases).

Conclusions. There seem to be no major differences in the structure, early diagnostic approach or management of ACE mimics between referrals from ambulance physicians and ambulance paramedics, which provides reassurance to healthcare systems that rely solely on paramedics. Mimics referred by non ambulance physicians appear different in structure and are less resource-consuming.

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Keywords

stroke, transient ischaemic attack, misdiagnosis, ambulance, paramedics, emergency department

About this article
Title

Stroke and TIA mimics in patients referred to a neurological emergency department by non-ambulance physicians, ambulance physicians and paramedics

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 53, No 1 (2019)

Pages

83-89

Published online

2019-01-04

DOI

10.5603/PJNNS.a2019.0002

Pubmed

30614515

Bibliographic record

Neurol Neurochir Pol 2019;53(1):83-89.

Keywords

stroke
transient ischaemic attack
misdiagnosis
ambulance
paramedics
emergency department

Authors

Dorota Kozera-Strzelińska
Michał Karliński
Grzegorz Rak
Magdalena Wojdacz
Halina Sienkiewicz-Jarosz
Iwona Kurkowska-Jastrzębska

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