NEW ORLEANS—Inpatient stroke alerts are significantly more likely to be false alarms than are stroke alerts initiated by emergency medical services (EMS) or those treated at an emergency department, according to findings presented at the 2008 International Stroke Conference. In addition, inpatient strokes are less likely to be treated with acute thrombolytic therapy than are strokes called in by EMS or observed at the emergency department, reported Don B. Smith, MD, and colleagues.
“Metabolic disturbances are more likely to account for inpatient false alarms than for EMS/emergency department false alarms,” said Dr. Smith. “Recent surgery and recent stroke are more often reasons for not using acute thrombolytic therapy for inpatient strokes.” Dr. Smith is a Clinical Professor of Neurology at the University of Colorado Health Sciences Center and Medical Director of the Stroke Program at the Colorado Neurological Institute and Swedish Medical Center in Englewood.
Inpatient Versus Outpatient Stroke Alerts
The researchers analyzed all stroke alerts from their database that occurred from February 2004 through June 2007. A total of 571 stroke alerts were phoned in by EMS, 288 stroke alerts occurred in the emergency department, and 73 stroke alerts occurred among inpatients. Dr. Smith and colleagues found that a combined 32% of stroke alerts from EMS and the emergency department were not actually strokes, compared with a 51% inaccuracy of inpatient stroke alerts. A combined 21% of patients whose stroke alerts were related to EMS and the emergency department received acute thrombolytic therapy, compared with 7% of inpatient stroke alerts.
Metabolic disturbances accounted for 24% of inpatient false-positive alerts, compared with 10% of EMS/emergency department false-positive alerts. Recent surgery was the leading reason inpatients did not receive acute thrombolytic therapy (18% of cases) but accounted for less than 1% of EMS/emergency department stroke alert cases that did not receive therapy. About 9% of inpatient stroke alerts did not result in therapy, due to recent strokes, compared with 2% of EMS/emergency department stroke alerts.
—Colby Stong