Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study
Objectives To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.Design This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke....
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BMJ Publishing Group
2025-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/2/e088014.full |
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| author | Jawad Haider Butt Christina Kruuse Heidi Shil Eddelien Viktor Frederik Idin Sørensen |
| author_facet | Jawad Haider Butt Christina Kruuse Heidi Shil Eddelien Viktor Frederik Idin Sørensen |
| author_sort | Jawad Haider Butt |
| collection | DOAJ |
| description | Objectives To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.Design This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.Setting Two non-comprehensive stroke centres in Denmark.Participants Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.Outcome measures Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.Results Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p<0.05 for all variables).Conclusion Patient-reported vertigo and migraine are common stroke mimics. Increasing age and unilateral limb symptoms increase the likelihood of a stroke. Although symptoms are similar, prehospital pathways differ between mimics and genuine patients with stroke. |
| format | Article |
| id | doaj-art-c1708e449bba418fb1e3cb730dc4d04e |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-c1708e449bba418fb1e3cb730dc4d04e2025-02-06T03:40:13ZengBMJ Publishing GroupBMJ Open2044-60552025-02-0115210.1136/bmjopen-2024-088014Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational studyJawad Haider Butt0Christina Kruuse1Heidi Shil Eddelien2Viktor Frederik Idin Sørensen3Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, DenmarkDepartment of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, DenmarkDepartment of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, DenmarkDepartment of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Herlev, DenmarkObjectives To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.Design This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.Setting Two non-comprehensive stroke centres in Denmark.Participants Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.Outcome measures Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.Results Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p<0.05 for all variables).Conclusion Patient-reported vertigo and migraine are common stroke mimics. Increasing age and unilateral limb symptoms increase the likelihood of a stroke. Although symptoms are similar, prehospital pathways differ between mimics and genuine patients with stroke.https://bmjopen.bmj.com/content/15/2/e088014.full |
| spellingShingle | Jawad Haider Butt Christina Kruuse Heidi Shil Eddelien Viktor Frederik Idin Sørensen Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study BMJ Open |
| title | Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study |
| title_full | Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study |
| title_fullStr | Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study |
| title_full_unstemmed | Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study |
| title_short | Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study |
| title_sort | patient reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack a cross sectional observational study |
| url | https://bmjopen.bmj.com/content/15/2/e088014.full |
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