Objectives

Stroke-like symptoms may be difficult to appreciate due to the high incidence of stroke mimics (e.g., delirium) in the inpatient population. Many centers have adopted inpatient-specific stroke protocols with the aim of improving time to diagnosis and treatment. We aimed to assess one of these instruments, the "2CAN" score, in our patient population.

Materials and methods

A retrospective chart review was conducted for all inpatients for whom our Brain Attack Team (BAT) was called between January 2015 and June 2019. Patients were excluded if they had stroke prior to current admission, were in the emergency department at the time of BAT call, or had incomplete documentation. The 2CAN score was calculated for each patient.

Results

The BAT was activated 201 times, and 110 patients met inclusion criteria. Twenty percent of patients had a history of atrial fibrillation, 72% hypertension, and 36% diabetes. Median NIHSS was 14.5 (IQR 5–24). Only 18% of stroke calls occurred within 24 h of hospital admission. The mean 2CAN score was 2.8. Ninety-seven (88%) patients received a final diagnosis of ischemic stroke and 13 (12%) of stroke mimics. There was no difference between 2CAN scores in the stroke and mimic groups (P = 0.91). A 2CAN score of ≥ 2 had sensitivity 83.5%, specificity 23.1%, PPV 89.0%, and NPV 15.8% for stroke.

Conclusions

The 2CAN score was derived and validated in a single academic center as a tool to recognize inpatient stroke. The 2CAN score had good sensitivity and positive predictive value for stroke in our cohort, but poor specificity.

中文翻译：

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优化院内卒中的识别和治疗：2CAN 评分评估

目标

由于住院患者中中风类似物（例如谵妄）的发生率很高，因此可能难以识别中风样症状。许多中心采用了针对住院患者的中风方案，目的是缩短诊断和治疗的时间。我们的目标是在我们的患者群体中评估这些工具之一，即“2CAN”评分。

材料和方法

对 2015 年 1 月至 2019 年 6 月期间召集我们的脑攻击团队 (BAT) 的所有住院患者进行了回顾性图表审查。 如果患者在目前入院前患有中风，在 BAT 呼叫时在急诊室，则将其排除在外，或文档不完整。计算每位患者的 2CAN 评分。

结果

BAT被激活201次，110名患者符合纳入标准。20% 的患者有房颤病史，72% 有高血压病史，36% 有糖尿病病史。NIHSS 中位数为 14.5（IQR 5-24）。只有 18% 的中风呼叫发生在入院 24 小时内。平均 2CAN 得分为 2.8。97 名 (88%) 患者最终诊断为缺血性中风，13 名 (12%) 为中风模拟患者。卒中组和模拟组的 2CAN 评分没有差异（P  = 0.91）。≥ 2 的 2CAN 评分对卒中的敏感性为 83.5%，特异性为 23.1%，PPV 为 89.0%，NPV 为 15.8%。

结论

2CAN 评分是在一个学术中心得出并验证的，作为识别住院中风的工具。在我们的队列中，2CAN 评分对卒中具有良好的敏感性和阳性预测值，但特异性较差。