Abstract TP365: Clinical Predictors of Ischemic Stroke in Patients Presenting With Altered Mental Status

Abstract

Introduction: Acute changes in mental status could be secondary to an acute ischemic stroke and is often a diagnostic dilemma in the emergency department. Identifying clinical parameters with the highest correlation with the diagnosis of stroke would help guide timely diagnostic studies and appropriate treatment. Hypothesis: We aimed to establish clinical predictors of acute stroke as compared to non-stroke diagnosis, in patients presenting with altered mental status in the emergency department. Methods: We studied clinical characteristics of a cohort of patients presenting with the chief complaint of altered mental status to four emergency departments in the state of Minnesota, over a five-year period (2011 to 2016) and have received an MRI of the brain within one week of admission. Two groups were defined based on diagnose at discharge: patients diagnosed with ischemic stroke (stroke group) and patients with a different diagnose than ischemic stroke (non-stroke group). Results: A total of 841 patients met the inclusion criteria. Neurology consult was requested in 56% of the patients, a focal neurological deficit was reported in 20% of the patients and stroke alert was called in 8% of the patients. Ischemic stroke was diagnosed in 16% of the patients. Multiple strokes affecting various brain structures, left frontal lobe and left parietal lobe were the most frequent ischemic stroke locations identified in patients with altered mental status. Focal neurological deficit (p < 0.0001), older age (p < 0.0001), speech disturbance (p = 0.0003), prior stroke/TIA (p < 0.005), prior hypertension (p < 0.0005) and prior hypercholesterolemia (p < 0.0002) are the clinical predictors that were significantly more frequent in patient diagnosed with ischemic stroke compared with non-stroke patients. In conclusion, a significant number of patients presenting in the emergency department with altered mental status have acute ischemic stroke. Identified clinical predictors in this study may contribute to differentiate stroke from non-stroke patients with altered mental status. Further work will include a predictive model and a screening tool to detect an ischemic stroke as the underlying diagnosis of patients presenting with acute mental status changes.