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2020 ; 29
(9
): 105022
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Encephalopathy only stroke codes (EoSC) do not result in rt-PA treatments
#MMPMID32807437
Chen PM
; Meyer DM
; Meyer BC
J Stroke Cerebrovasc Dis
2020[Sep]; 29
(9
): 105022
PMID32807437
show ga
BACKGROUND: Isolated mental status changes as a presenting sign (EoSC+), are not
uncommon stroke code triggers. As stroke alerts, they still require the same
intensive resources be applied. We previously showed that EoSC+ strokes (EoSC+
Stroke+) account for 0.1-0.2% of all codes. Whether these result in thrombolytic
treatment (rt-PA), and the characteristics/ risk factor profiles of EoSC+ Stroke+
patients, have not been reported. METHODS: Retrospective analysis of stroke codes
from an IRB approved registry, from 2004 to 2018, was performed. EoSC+ was
defined as a NIHSS>0 for Q1a, 1b, or 1c with remaining elements scored 0.
Characteristics and risk factors were compared for EoSC+, EoSC-, EoSC+ Stroke+,
and rt-PA (EoSC+ Stroke+TPA+) patients. RESULTS: EoSC+ occurred in 55/2982
(1.84%) of all stroke codes. EoSC+ Stroke+ occurred in 8/55 (14.5%) of EoSC+
codes and 8/2982 (0.27%) of all stroke codes. 6/8 (75%) of EoSC+ Stroke+ scored
NIHSS=1. When comparing EoSC++versus EoSC-, Hispanic ethnicity (p=0.009),
hypertension (p=0.02), and history of stroke/TIA (p=0.002) were less common in
EoSC+. No demographic/risk factor differences were noted for EoSC+ Stroke+ vs.
EoSC+ Stroke-. No cases of rt-PA eligibility/treatment were noted. In EoSC+
Stroke+ analysis, imaging positive stroke/intracranial hemorrhage was noted on
only 3 cases (3/2982=0.10% of all stroke codes) and none were posterior stroke.
CONCLUSIONS: EoSC+ rarely results in stroke/TIA (0.27%) or stroke (0.10%), and in
our analysis never (0%) resulted in rt-PA. Sub-analysis did not show missed rt-PA
or posterior strokes. Understanding characteristics, and knowing that EoSC+
Stroke+ patients are unlikely to receive rt-PA, may help triage stroke resources.
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