Predicting Stroke Mimics in Telestroke Consultations (4358)

Objective: NA Background: Telestroke consultation is increasingly used to provide stroke care. Much like in-person stroke consults, stroke mimics are common. This study sought to identify patient and hospital characteristics more likely to be associated with a Telestroke diagnosis of stroke mimic. Design/Methods: We analyzed 2 years of video consults by the VA National Telestroke Program (NTSP). Stroke mimic was defined as a Telestroke consult coded as a diagnosis of “other.” Text responses for “other” diagnoses were grouped into clinical categories. We used Chi-squared and t-tests analysis to compare characteristics of patients with a stroke mimic diagnosis and those without. Co-variates included age, gender, co-morbid conditions, NIHSS, time of consult (night/weekend vs day), location of consult (emergency department vs inpatient), hospital rurality; hospital consult volume, and duration of institutional participation in NTSP at time of consult. Variables with a p-value Results: There were 561 stroke mimics. The most common mimics were toxic metabolic encephalopathy (19%) and seizure (12%). Variables significantly associated with stroke mimic in bivariate analyses were age, gender, history of alcohol abuse, history of atrial fibrillation, history of dementia, NIHSS, nights/weekend consults, and hospital rurality. In multivariate analyses, female sex [OR=1.63, p=0.001], inpatient consultations [OR=1.55, p= 0.019], history of dementia [OR=1.85, p=0.0002], and alcohol abuse [OR=1.42, p=0.002] were associated with a stroke mimic. Consults during nights/weekends [OR=0.76, p=0.001], and patients with atrial fibrillation [OR=0.81, p=0.031], increasing age [OR=0.90, p=0.019], and increasing NIHSS [OR=0.97, p=0.0042] were less likely to be a mimic. Conclusions: Patient and consult characteristics influenced the likelihood of a stroke mimic diagnosis. Medical history may reflect conditions likely to cause neurologic symptoms, and patients hospitalized with new symptoms represent a challenging subset to accurately distinguish stroke from mimics. Awareness of these factors may alert providers to diagnoses other than stroke. Disclosure: Dr. Siriwardane has nothing to disclose. The institution of Dr. Williams has received research support from VA HSR&D. Holly Martin has nothing to disclose. Brandon Edwards has nothing to disclose. Michelle LaPradd has received personal compensation in the range of $50,000-$99,999 for serving as a Biostatistician with Indiana University. Michelle LaPradd has a non-compensated relationship as a Biostatistician Consultant with Vetrans Affairs that is relevant to AAN interests or activities. The institution of Joanne Daggy has received research support from VA HSR&D. Joanne Daggy has received personal compensation in the range of $500-$4,999 for serving as a Statistical Reviewer with General Dynamics Information Technology. Laura Myers has nothing to disclose. Dr. Graham has received personal compensation for serving as an employee of Department of Veterans Affairs. An immediate family member of Dr. Graham has received personal compensation for serving as an employee of Department of Veterans Affairs. Dr. Graham has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Rodey Law Firm. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Romaguera Law Group. Dr. Graham has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Lewis Brisbois. The institution of Dr. Graham has received research support from Department of Veterans Affairs. Dr. Graham has received personal compensation in the range of $10,000-$49,999 for serving as a Speaker with MER (non-profit CME provider). Dr. Martini has nothing to disclose. The institution of Jane Anderson has received research support from VHA Rehabilitation Research. Jane Anderson has received personal compensation in the range of $100,000-$499,999 for serving as a Director of Education & Research VA Telestroke Program with Veterans Health Administration.