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Wenstrup J, Blomberg SN, Christensen H, Folke F, Christensen HC, Kruuse C. Dispatcher Stroke/TIA Recognition in Emergency Medical Call Center and Out-of-Hours Service Calls in Copenhagen, Denmark. Neurol Clin Pract 2023; 13:e200197. [PMID: 37854175 PMCID: PMC10581077 DOI: 10.1212/cpj.0000000000200197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 07/24/2023] [Indexed: 10/20/2023]
Abstract
Background and Objectives Recognition of stroke/TIA symptoms by emergency medical services (EMS) is instrumental in providing timely recanalization treatments. We assessed the recognition of stroke/TIA by EMS via the emergency medical call center (EMCC) dispatchers and out-of-hours health service (OOHS) dispatchers. Methods In a registry study, based on 2015-2020 data from the Copenhagen EMS, we calculated sensitivity, positive predictive value (PPV), specificity, and negative predictive value (NPV) of dispatcher suspicion of stroke or transient ischemic attack (TIA) and compared against discharge diagnosis. Results We included 462,029 contacts to EMCC and 2,573,865 contacts to OOHS. In total, 19,798 contacts had a stroke or TIA diagnosis at hospital discharge. Sensitivity was 0.64 for EMCC dispatchers and 0.25 for OOHS. PPV was 0.28 for EMCC and 0.22 for OOHS; specificity was 0.96 for EMCC and >0.99 for OOHS, and NPV was 0.99 for EMCC and >0.99 for OOHS. Sensitivity improved over the period of the study from 0.62 to 0.68 for EMCC and from 0.20 to 0.25 for OOHS. PPV did not change over the period for EMCC and decreased from 0.26 to 0.19 for OOHS. Both EMCC and OOHS more frequently overlooked stroke in women, in patients calling more than 3 hours after symptom onset, and for more severe strokes. For OHHS, advanced age correlated with lower recognition. Discussion As the first study reporting on OOHS setting dispatcher stroke/TIA recognition, we find a need for the improvement of stroke/TIA recognition both in EMCC and in OOHS. Solutions may include specific training of dispatchers, public awareness campaigns, and new technological solutions.
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Affiliation(s)
- Jonathan Wenstrup
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Stig N Blomberg
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Hanne Christensen
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Fredrik Folke
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Helle C Christensen
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - Christina Kruuse
- Department of Neurology (JW, CK), Copenhagen University Hospital - Herlev and Gentofte; Emergency Medical Services Copenhagen (JW, FF, HCC), Denmark; Emergency Medical Services (SNB), Region Zealand; Department of Neurology (HC), Copenhagen University Hospital - Bispebjerg and Frederiksberg; Department of Clinical Medicine (HC, FF HCC, CK), University of Copenhagen; and Department of Cardiology (FF), Copenhagen University Hospital - Herlev and Gentofte, Denmark
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Helboe KS, Eddelien HS, Kruuse C. Visual symptoms in acute stroke - A systematic review of observational studies. Clin Neurol Neurosurg 2023; 229:107749. [PMID: 37163931 DOI: 10.1016/j.clineuro.2023.107749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Atypical symptoms of stroke, such as non-specific visual symptoms, are a challenging aspect of acute stroke diagnostics. Among patients evaluated for stroke in the Emergency Department, 2-28% present with stroke chameleons, and 30-43% with stroke mimics. We aimed to identify the type of visual symptoms present in typical strokes, stroke mimics, and stroke chameleons. PATIENTS AND METHODS By use of Preferred Reporting Items for Systematic Reviews and Meta-Analysis we searched PubMed and Embase for studies with reports of acute visual symptoms in typical strokes vs mimics or chameleons (PROSPERO protocol, ID CRD42022364749). Risk of bias was assessed by The Critical Appraisal Skills Program. RESULTS Thirteen papers were included, comprising data from 9248 patients evaluated for stroke. Compared to mimics, visual symptoms in stroke presented more frequently as hemianopia (28.2% vs 4.8%, 7,4% vs 2.3%, 22% vs 0%), visual loss (11.6% vs 1.8%), visual field defect (11.6% vs 4%, 24% vs 2%, 19% vs 1.7%), eye movement disorder (19.4% vs 6.4%), eye deviation (9.6% vs 0.9%), gaze palsy (32.1% vs 8.6%), oculomotor disturbance (37% vs 0%), and visual inattention (17.5% vs 4%). Compared to strokes, mimics more often presented "non-systematized visual trouble" (10% vs 3%) and blurred vision (22% vs 5%), whereas "visual disturbance" was reported more often in stroke chameleons than in typical strokes (10% vs 3%). CONCLUSION Detailed reports of visual symptoms were lacking in most studies, however blurred vision and "non-systematized visual trouble" were more frequent in mimics, "visual disturbance" in stroke chameleons, and negative visual symptoms such as visual field defects in typical strokes. A more systematic and detailed approach to visual symptoms may facilitate acute stroke recognition in patients with visual symptoms.
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Affiliation(s)
- Katrine Sofie Helboe
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark & Dept of Clinical Medicine, University of Copenhagen, Denmark
| | - Heidi Shil Eddelien
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark & Dept of Clinical Medicine, University of Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark & Dept of Clinical Medicine, University of Copenhagen, Denmark.
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Komulainen T, Koivisto A, Jäkälä P. Incidence of first-ever transient ischemic attack in Eastern Finland. Acta Neurol Scand 2022; 146:615-622. [PMID: 36029100 PMCID: PMC9805147 DOI: 10.1111/ane.13689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The incidence of stroke has been declining in Finland, as well as in Europe. However, it is unclear whether the incidence of transient ischemic attack (TIA) is also decreasing. In fact, the TIA incidence in the Finnish population has never been reported. Therefore, here we investigated the incidence of TIA in the Eastern Finnish population in 2017. MATERIALS AND METHODS All patients with suspected TIA, from a defined catchment area, were referred to a neurological emergency unit at Kuopio University Hospital (KUH) in the Northern Savonia region of Eastern Finland, which had a population of 246,653 in 2017. The original study population comprised TIA patients diagnosed based on the WHO TIA criteria in 2017. Incidence rates were calculated by dividing the number of TIA cases by the number of people in different age groups. RESULTS Among 432 patients with a suspected TIA referred to the neurological emergency unit at Kuopio University Hospital in 2017, 293 were living in Northern Savonia and were ultimately diagnosed with TIA after neurological examinations. The number of first-ever TIAs was 211. The crude incidence of all TIA was 122/100,000 inhabitants, and of first-ever TIA was 86/100,000. The age-standardized incidence (European population 2010) of the first-ever TIA was calculated to be 64/100,000. The mean age of first-ever TIA patients was 70 years: 72 years for women versus 68 years for men. CONCLUSIONS We found a high incidence of TIA in Eastern Finland.
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Affiliation(s)
- Tiina Komulainen
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
| | - Anne Koivisto
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland,Geriatrics, Internal Medicine and RehabilitationHelsinki University HospitalHelsinkiFinland,Department of NeurosciencesUniversity of HelsinkiHelsinkiFinland
| | - Pekka Jäkälä
- Department of NeurologyKuopio University Hospital NeurocenterKuopioFinland,Department of Neurology, Institute of Clinical MedicineUniversity of Eastern FinlandKuopioFinland
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