PMID- 29374105
OWN - NLM
STAT- MEDLINE
DCOM- 20180315
LR  - 20200430
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Print)
IS  - 0039-2499 (Linking)
VI  - 49
IP  - 3
DP  - 2018 Mar
TI  - Validating the TeleStroke Mimic Score: A Prediction Rule for Identifying Stroke 
      Mimics Evaluated Over Telestroke Networks.
PG  - 688-692
LID - 10.1161/STROKEAHA.117.018758 [doi]
AB  - BACKGROUND AND PURPOSE: Up to 30% of acute stroke evaluations are deemed stroke 
      mimics, and these are common in telestroke as well. We recently published a risk 
      prediction score for use during telestroke encounters to differentiate stroke 
      mimics from ischemic cerebrovascular disease derived and validated in the 
      Partners TeleStroke Network. Using data from 3 distinct US and European 
      telestroke networks, we sought to externally validate the TeleStroke Mimic (TM) 
      score in a broader population. METHODS: We evaluated the TM score in 1930 
      telestroke consults from the University of Utah, Georgia Regents University, and 
      the German TeleMedical Project for Integrative Stroke Care Network. We report the 
      area under the curve in receiver-operating characteristic curve analysis with 95% 
      confidence interval for our previously derived TM score in which lower TM scores 
      correspond with a higher likelihood of being a stroke mimic. RESULTS: Based on 
      final diagnosis at the end of the telestroke consultation, there were 630 of 1930 
      (32.6%) stroke mimics in the external validation cohort. All 6 variables included 
      in the score were significantly different between patients with ischemic 
      cerebrovascular disease versus stroke mimics. The TM score performed well (area 
      under curve, 0.72; 95% confidence interval, 0.70-0.73; P<0.001), similar to our 
      prior external validation in the Partners National Telestroke Network. 
      CONCLUSIONS: The TM score's ability to predict the presence of a stroke mimic 
      during telestroke consultation in these diverse cohorts was similar to its 
      performance in our original cohort. Predictive decision-support tools like the TM 
      score may help highlight key clinical differences between mimics and patients 
      with stroke during complex, time-critical telestroke evaluations.
CI  - (c) 2018 American Heart Association, Inc.
FAU - Ali, Syed F
AU  - Ali SF
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Hubert, Gordian J
AU  - Hubert GJ
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Switzer, Jeffrey A
AU  - Switzer JA
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Majersik, Jennifer J
AU  - Majersik JJ
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Backhaus, Roland
AU  - Backhaus R
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Shepard, L Wylie
AU  - Shepard LW
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Vedala, Kishore
AU  - Vedala K
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.).
FAU - Schwamm, Lee H
AU  - Schwamm LH
AD  - From the Department of Neurology, Massachusetts General Hospital, Harvard Medical 
      School, Boston (S.F.A., L.H.S.); Department of Neurology and Neurological 
      Intensive Care, Staedtisches Klinikum Munchen, TeleMedical Project for 
      integrative Stroke Care, Munich, Germany (G.J.H.); Department of Neurology, 
      Augusta University, GA (J.S., K.V.); Division of Vascular Neurology, University 
      of Utah, Salt Lake City (J.J.M., L.W.S.); and Department of Neurology, University 
      Regensburg, Germany (R.B.). lschwamm@partners.org.
LA  - eng
GR  - U10 NS086606/NS/NINDS NIH HHS/United States
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Validation Study
DEP - 20180126
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
MH  - Brain Ischemia/*diagnosis
MH  - *Decision Making
MH  - Female
MH  - Humans
MH  - Male
MH  - Stroke/*diagnosis
MH  - Telemedicine/instrumentation/*methods
PMC - PMC5829006
MID - NIHMS934876
OTO - NOTNLM
OT  - area under curve
OT  - cerebrovascular disorders
OT  - cohort studies
OT  - humans
OT  - risk
EDAT- 2018/01/28 06:00
MHDA- 2018/03/16 06:00
PMCR- 2019/03/01
CRDT- 2018/01/28 06:00
PHST- 2017/07/14 00:00 [received]
PHST- 2017/11/28 00:00 [revised]
PHST- 2017/12/07 00:00 [accepted]
PHST- 2018/01/28 06:00 [pubmed]
PHST- 2018/03/16 06:00 [medline]
PHST- 2018/01/28 06:00 [entrez]
PHST- 2019/03/01 00:00 [pmc-release]
AID - STROKEAHA.117.018758 [pii]
AID - 10.1161/STROKEAHA.117.018758 [doi]
PST - ppublish
SO  - Stroke. 2018 Mar;49(3):688-692. doi: 10.1161/STROKEAHA.117.018758. Epub 2018 Jan 
      26.