Prehospital assessment of suspected stroke and TIA: An observational study.

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Symptoms related to stroke diverge and may mimic many other conditions. 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). An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. Of 1081 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. Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.