Objectives

Telestroke consultations enable hospital providers to administer intravenous (IV) alteplase to patients who would otherwise not receive it due to lack of an in-hospital stroke team. However, up to 30% of acute stroke patient evaluations are deemed to be stroke mimics. Mimics present a challenge with the limitations of a virtual neurological exam. The administration of IV alteplase in these patients is not without risk. With the cost and risk associated with IV alteplase, there are both ethical and practical incentives to avoid administering alteplase to a patient manifesting a stroke-mimic. Recently a retrospective analysis validated a TeleStroke Mimic Score (TM-Score) to help detect stroke mimics. We retrospectively applied this tool to Mayo Clinic Stroke Telemedicine for Arizona Rural Residents (STARR) telestroke database to provide external validation in an independent study population.

Materials and Methods

We analyzed 339 patients in the STARR database for validation of the TM-Score, which was applied retrospectively to determine whether it predicted stroke-mimic, using data available during each patient's telestroke consult. We assessed the TM-Score's performance with a receiver-operating characteristic (ROC) curve. A scatter plot of the data was assembled to demonstrate the relationship between the TM-Score and the likelihood of having a stroke mimic, and was compared to the nomogram in the original TM-Score study.

Results

When the TM-Score was applied to Mayo Clinic STARR validation cohort, the area under the ROC curve was 0.78, larger than that of the derivation cohort in the original study (0.75). Further analysis suggested that a TM-Score > 25 or < 10 provided a greater degree of confidence that the patient had presented with stroke or stroke mimic, respectively. In STARR cohort, additional variables were significantly different between stroke and stroke mimic populations, including a history of sleep apnea and diabetes.

Conclusions

We determined that the original TM-Score was valid when applied to Mayo Clinic STARR telestroke population.

中文翻译：

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在 Mayo Clinic 人群中验证 Telestroke Mimic Sc​​ore

目标

远程卒中咨询使医院提供者能够向因缺乏住院卒中团队而无法接受静脉注射 (IV) 阿替普酶的患者给药。然而，高达 30% 的急性中风患者评估被认为是中风模拟。模拟对虚拟神经系统检查的局限性提出了挑战。在这些患者中静脉注射阿替普酶并非没有风险。考虑到与 IV 阿替普酶相关的成本和风险，有道德和实际动机来避免对表现出中风模拟的患者使用阿替普酶。最近一项回顾性分析验证了 TeleStroke Mimic Sc​​ore (TM-Score) 以帮助检测中风模拟。

材料和方法

我们分析了 STARR 数据库中的 339 名患者以验证 TM-Score，该评分被回顾性应用以确定它是否预测中风模拟，使用每个患者的远程中风咨询期间可用的数据。我们使用受试者工作特征 (ROC) 曲线评估了 TM-Score 的表现。收集数据的散点图以证明 TM-Score 与中风模拟的可能性之间的关系，并将其与原始 TM-Score 研究中的列线图进行比较。

结果

当 TM-Score 应用于 Mayo Clinic STARR 验证队列时，ROC 曲线下面积为 0.78，大于原始研究中推导队列的面积 (0.75)。进一步的分析表明，TM-Score > 25 或 < 10 分别提供了更大程度的置信度，即患者曾出现过中风或中风模拟。在 STARR 队列中，中风和中风模拟人群之间的其他变量显着不同，包括睡眠呼吸暂停和糖尿病史。

结论

我们确定原始 TM-Score 在应用于 Mayo Clinic STARR 远程卒中人群时是有效的。