Abstract TP300: Is Stroke Code Activation for Stroke Mimics Decreasing With Stroke Center Certification

Abstract

Introduction: There has been extensive education required as part of the Joint Commission (TJC) stroke center certification to rapidly identify acute stroke patients. One study found from 1998 to 2001, 25.3% of stroke codes (SC) were deemed stroke mimics (SM). The purpose of this study was to assess if SC activation in true stroke (TS) patients has improved as part of TJC certification. Methods: This study was a retrospective, observational study of prospectively collected data from an IRB approved Stroke Registry. This includes all SC managed by the stroke team from June 2006-June 2018. Data collected includes initial diagnosis, final diagnosis, demographics, and treatment variables. Analysis included all patients in the registry. Final diagnosis was adjudicated by stroke faculty. Baseline demographics, medical history, treatments, and baseline NIHSS were assessed. Data was examined for frequencies and distribution. Baseline demographics and correlations were compared as appropriate. Results: Of all SC (n=4602), 2100 were SM (45.6%). SM were associated with lower age and blood pressure, history of seizure or dementia, female sex, and black race (Table 1). SM also had a lower median NIHSS (3 vs 6, p<0.0001). Of SM, 62/2100 (3%) received IV rt-PA. The most common SM final diagnoses were other, somatization, seizure, encephalopathy and migraine (Figure 1). Conclusions: In this large retrospective, study, 45.6% of SC activations were SM. This is a significant increase in the number of SM captured in previous studies. These results show healthcare professionals are overly cautious at alerting a stroke code as they do not want to miss an opportunity to provide thrombolytic treatment.