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J Korean Soc Emerg Med > Volume 29(5); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(5): 437-448.
Clinical features and risk factors for missed stroke team activation in cases of acute ischemic stroke in the emergency department
Young-Hoon Byun1, Sung-Youp Hong1, Seon-Hee Woo2, Hyun-Jeong Kim3, Si-Kyoung Jeong1
1Department of Emergency Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
2Department of Emergency Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
3Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
Correspondence  Si-Kyoung Jeong ,Tel: 042-220-9408, Fax: 042-256-6810, Email: sikyoung@catholic.ac.kr,
Received: June 8, 2018; Revised: July 18, 2018   Accepted: September 15, 2018.  Published online: October 31, 2018.
Acute ischemic stroke (AIS) requires time-dependent reperfusion therapy, and early recognition of AIS is important to patient outcomes. This study was conducted to identify the clinical features and risk factors of AIS patients that are missed during the early stages of diagnosis.
We retrospectively reviewed AIS patients admitted to a hospital through the emergency department. AIS patients were defined as ischemic stroke patients who visited the emergency department within 6 hours of symptom onset. Patients were classified into two groups: an activation group (A group), in which patients were identified as AIS and the stroke team was activated, and a non-activation group (NA group), for whom the stroke team was not activated.
The stroke team was activated for 213 of a total of 262 AIS patients (81.3%), while it was not activated for the remaining 49 (18.7%). The NA group was found to be younger, have lower initial National Institutes of Health Stroke Scale scores, lower incidence of previous hypertension, and a greater incidence of cerebellum and cardio-embolic infarcts than the A group. The chief complaints in the A group were traditional stroke symptoms, side weakness (61.0%), and speech disturbance (17.8%), whereas the NA group had non-traditional symptoms, dizziness (32.7%), and decreased levels of consciousness (22.4%). Independent factors associated with missed stroke team activation were nystagmus, nausea/vomiting, dizziness, gait disturbance, and general weakness.
A high index of AIS suspicion is required to identify such patients with these findings. Education on focused neurological examinations and the development of clinical decision tools that could differentiate non-stroke and stroke are needed.
Key words: Acute ischemic stroke; Stroke team; Missed activation
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