Diagnostic accuracy of telestroke consultation: a Louisiana based tele-network experience

Frontiers in Neurology

Neurology

Alaa E. Mohammed¹  Robin D. Ulep²  Gage A. Stuntz²  Sara Mitchell²  Ifeanyi O. Iwuchukwu³  Richard M. Zweifler³  Mugilan Poongkunran³  Gabriel Vidal³  Daniel Chehebar³  Harold McGrade³  Kenneth J. Gaines³ 

[1] Ochsner Center for Outcomes Research, Office of Epidemiology and Biostatistical Collaborations, Ochsner Clinic Foundation, New Orleans, LA, United States;Ochsner Clinical School, New Orleans, LA, United States;Ochsner Neuroscience Institute, Ochsner Health, New Orleans, LA, United States;

关键词: telestroke;    telemedicine;    teleneurology;    accuracy;    MIMICS;   

DOI  :  10.3389/fneur.2023.1141059

 received in 2023-01-17, accepted in 2023-05-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background and purposeTelestroke has grown significantly since its implementation. Despite growing utilization, there is a paucity of data regarding the diagnostic accuracy of telestroke to distinguish between stroke and its mimics. We aimed to evaluate diagnostic accuracy of telestroke consultations and explore the characteristics of misdiagnosed patients with a focus on stroke mimics.MethodsWe conducted a retrospective study of all the consultations in our Ochsner Health’s TeleStroke program seen between April 2015 and April 2016. Consultations were classified into one of three diagnostic categories: stroke/transient ischemic attack, mimic, and uncertain. Initial telestroke diagnosis was compared with the final diagnosis post review of all emergency department and hospital data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) for diagnosis of stroke/TIA versus mimic were calculated. Area under receiver-operating characteristic curve (AUC) analysis to predict true stroke was performed. Bivariate analysis based on the diagnostic categories examined association with sex, age, NIHSS, stroke risk factors, tPA given, bleeding after tPA, symptom onset to last known normal, symptom onset to consult, timing in the day, and consult duration. Logistic regression was performed as indicated by bivariate analysis.ResultsEight hundred and seventy-four telestroke evaluations were included in our analysis. Accurate diagnosis through teleneurological consultation was seen in 85% of which 532 were strokes (true positives) and 170 were mimics (true negatives). Sensitivity, specificity, PPV, NPV were 97.8, 82.5, 93.7 and 93.4%, respectively. LR+ and LR− were 5.6 and 0.03. AUC (95% CI) was 0.9016 (0.8749–0.9283). Stroke mimics were more common with younger age and female gender and in those with less vascular risk factors. LR revealed OR (95% CI) of misdiagnosis for female gender of 1.9 (1.3–2.9). Lower age and lower NIHSS score were other predictors of misdiagnosis.ConclusionWe report high diagnostic accuracy of the Ochsner Telestroke Program in discriminating stroke/TIA and stroke mimics, with slight tendency towards over diagnosis of stroke. Female gender, younger age and lower NIHSS score were associated with misdiagnosis.

【 授权许可】

Unknown   
Copyright © 2023 Poongkunran, Ulep, Stuntz, Mitchell, Gaines, Vidal, Chehebar, Iwuchukwu, McGrade, Mohammed and Zweifler.