Abstract TP240: Dizziness Triage in Acute Posterior Circulation Stroke Identification

Abstract

Background: Posterior circulation strokes (PCS) is a challenge in Emergency Medicine. Incorrect diagnosis can lead to missed treatment with acute stroke therapy. FAST has not been shown to evaluate PCS symptoms: dizziness, ataxia & vision. The inclusion of balance to the BE-FAST has helped increase the capture rate of patients suspected with PCS, yet how this is assessed needs clarification. Defining disability for consideration of acute stroke therapy in the dizzy patient can be aided by gait assessment. Purpose: The purpose of this study is to identify any patterns of co-morbid conditions or assessment elements that would make identification of PCS easier by completing a retrospective chart review. The team also attempted to identify any trends in the patient’s physiologic response to stroke. Methods/Methodology: An IRB-approved retrospective, observational chart review was completed on patients that presented with PCS symptoms to the target hospital’s ED from January 2016 to May of 2017. Patients with the presence of a chief complaint OR reported symptom during physician initial interview of dizziness, vision loss, ataxia, or syncope AND completion of one imaging study were included in the study. The charts were abstracted for demographic information, symptoms reported/observed, vital signs, labs, imaging and final diagnosis. Results: Seventy-nine patients were coded as a stroke on discharge diagnosis from 378 patients with PCS symptoms. The mean SBP & DBP was greater in stroke patients ( p< .01 ) and the mean blood glucose measured higher in stroke patients ( p=0.01 ). The mean heart rate did not have a statistically significant difference. Dizzy/vertigo ( p=.022 ), gait disturbance/ataxia ( p=.017 ) correlated to stroke diagnosis and a BP over 200/100 trended towards significance ( p=.054 ), with 95% CI. Findings/Conclusion: A report of dizziness or vertigo, ataxia, and a higher measurement of blood glucose or blood pressure was correlated in those with a stroke diagnosis. In the setting of PCS symptoms, these triggers should raise awareness for increased likelihood of acute PCS. When attempting to identify PCS, walking the patient is a subtle addition to balance assessment that can provide important information to distinguish PCS.