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Prehospital assessment of suspected stroke and TIA: an observational study.
Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0003-4139-6235
Intensive Care Unit, NU-hospital.
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2019 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Symptoms related to stroke diverge and may mimic many other conditions.

AIMS: To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA) METHODS: An observational multi-centre study including nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the EMS clinician before hospital admission during a four-month period were included.

RESULTS: Of 1,081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, p=0.007, a history of myocardial infarction (OR: 1.77, p= 0.01), facial droop (OR: 2.81, p<0.0001), arm weakness (OR: 2.61, p<0.0001), speech disturbance (OR: 1.92, p<0.0001) and high systolic blood pressure (OR: 1.50, p=0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, p=0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up.

CONCLUSIONS: Seven factors including the three symptoms included in the Face Arm Speech Test (FAST) were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
2019.
Keywords [en]
Emergency Medical Services, diagnosis, mortality, stroke
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Other Medical Sciences
Identifiers
URN: urn:nbn:se:hb:diva-16022DOI: 10.1111/ane.13107PubMedID: 31009075OAI: oai:DiVA.org:hb-16022DiVA, id: diva2:1306667
Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-04-29Bibliographically approved

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Andersson Hagiwara, MagnusHerlitz, JohanWireklint Sundström, Birgitta

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