Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study

OBJECTIVES: To determine patient-reported symptoms and clinical factors associated with mimics and differences in health-seeking behaviour versus stroke.

DESIGN: This is a post-hoc analysis of a cross-sectional survey of interviews on patient-reported factors in patients admitted with suspected stroke. Patients were categorised as genuine stroke or mimic. The surveys were conducted from February 2018 to January 2019.

SETTING: Two non-comprehensive stroke centres in Denmark.

PARTICIPANTS: Patients≥18 years (no upper age limit) admitted with symptoms of stroke to one of the non-comprehensive stroke centres or transferred from a comprehensive- or primary stroke centre were eligible for inclusion. 592 patients were included.

OUTCOME MEASURES: Symptoms or clinical factors associated with stroke mimics. Logistic regression analysis was performed to identify factors associated with mimics. Secondarily, the number of strokes versus mimics presenting at a healthcare facility within 3 hours contacted the emergency medical service (EMS) and arrived by ambulance.

RESULTS: Of 592 suspected patients with stroke, 113 (19.1%) were mimics; most frequently peripheral vertigo (24.7%) and migraine (11.5%). Factors associated with a higher likelihood of mimics were female sex (OR 1.79, 95% CI 1.14 to 2.79), high Scandinavian Stroke Scale scores (OR 1.05, 95% CI 1.02 to 1.09, per point increase), and vertigo (OR 1.86, 95% CI 1.18 to 2.95). Factors associated with a lower likelihood of mimics were increasing age (OR 0.96, 95% CI 0.95 to 0.98 per year increase), reported limb weakness (OR 0.52, 95% CI 0.30 to 0.89) and difficulty steering (OR 0.51, 95% CI 0.28 to 0.93).There was no difference between groups in the proportion of patients for whom time from symptom onset to healthcare services contact exceeded 3 hours (52.2% vs 53.7%, p=0.78). Fewer mimics contacted the EMS first, were accepted at a primary stroke centre and arrived by ambulance (p<0.05 for all variables).

CONCLUSION: Patient-reported vertigo and migraine are common stroke mimics. Increasing age and unilateral limb symptoms increase the likelihood of a stroke. Although symptoms are similar, prehospital pathways differ between mimics and genuine patients with stroke.