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| Clinical stroke assessment 'streamlined' |
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23 February 2006
Researchers have identified eight variables that can reliably distinguish stroke from conditions that mimic stroke at clinical assessment. "Our findings show that the bedside clinical assessment can be streamlined substantially," say Dr Peter Hand, from Royal Melbourne Hospital in Victoria, Australia, and colleagues. The researchers stress that bedside clinical assessment is important, as it often determines the speed at which the patient receives more complex diagnostic procedures. But they note: "Despite the need for a rapid, confident diagnosis in the thrombolysis era, the clinical assessment has received little formal study."
The team therefore studied 350 patients hospitalised with suspected stroke, of whom 69% received a final diagnosis of stroke and 31% had a condition that mimicked stroke, the majority of which were neurological conditions. After multivariate analysis, the variables that predicted a diagnosis of stroke were: an exact time of onset; definite focal symptoms; abnormal vascular findings; the successful identification of a stroke subclassifiation; the presence of neurological signs, and being able to assign such signs to one side of the brain. Conversely, patients with cognitive impairment and abnormal signs in other systems were more likely to have a condition that mimicked stroke. 42% of patients with conditions mimicking stroke had a history of stroke and therefore abnormal brain scans, which they stress reinforces the need for neurologists, or stroke physicians with adequate neurological training, to be involved in the assessment of patients with brain attack.
Writing in the journal Stroke, the investigators conclude: "Much of what we have shown would be familiar to the experienced stroke clinician." However, they state: "With better knowledge of the key features that reliably distinguish stroke from mimic, as identified in our study, the inexperienced clinician's assessment can be brief but more focused and assured."
Reference:
Stroke 2006; 37 (2): 769-775.
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