Abstract TP264: Telestroke Diagnosis of Conversion Disorder

Abstract

Conversion Disorder (CD) is a common stroke mimic of ischemic stroke (IS) or TIA. Although studies comparing stroke mimics with IS or TIA exist, there is a paucity of data comparing demographic and clinical features of CD and IS/TIA and evaluating diagnostic accuracy of CD via telemedicine. Methods: We retrospectively reviewed telestroke consultations at our center between April 2015 and July 2016. All patients were assessed remotely using telestroke service by physicians at the Ochsner Neuroscience Institute. Consultations were classified into one of 2 diagnostic categories: IS/TIA and CD; other stroke mimics were excluded. Initial diagnosis was compared with final diagnosis, determined after review of additional emergency department testing or hospital admission. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosis of CD were calculated. Bivariate analysis based on the diagnostic categories was used to examine association with sex, age, NIH Stroke Scale (NIHSS), stroke risk factors (CAD, DM, HLD, HTN, history of stroke/TIA, smoking, atrial fibrillation (AFIB)), TPA given, bleeding after TPA, and consult duration. Area under receiver-operating curve (AUC) for telestroke diagnostic accuracy of CD was calculated. Results: 616 telestroke evaluations were included in our analysis. Sensitivity, specificity, NPV, PPV of CD diagnosis were 0.82, 0.998, 0.985 and 0.976, respectively. Variables that reached statistical significance between CD and IS/TIA were female gender (0.0006), age (<0.0001), DM (0.0252), HTN (0.0004), AFIB (<0.0001), TPA given (<0.0001), and median consult duration (0.0175). Median consult duration (min) of misdiagnosed cases was 27.5 (18.5, 32) and that of correctly diagnosed cases was 10.5 (7, 16). Adjusted AUC (95% CI) was 0.92 (0.87, 0.97). Conclusions: Our unadjusted telemedicine CD diagnostic accuracy is 0.98. In the bivariate analysis CD patients are more likely to be female, younger, and have no history of DM, HTN or AFIB compared with IS/TIA patients. CD patients received shorter consult time compared with IS/TIA patients, and received less TPA. CD misdiagnosed cases had a longer median consultation time than correctly diagnosed cases.