Clinical predictors of an acute stroke Vs. stroke mimic among code stroke patients: A single center retrospective study

Abstract

Background & Objective: There is an increasing rate of stroke mimics being identified in code stroke pathways, which adds to hospital staff workload and increased financial costs for patients. This study aims to identify clinical predictors that distinguish a true acute stroke from a stroke mimic in code stroke cases and to determine which neurological signs and symptoms are more strongly associated with a confirmed stroke diagnosis.

Methods: A single-center retrospective cross sectional descriptive study was conducted among code stroke patients seen in the Makati Medical Center emergency room from January 2024 to December 2024. Clinical history, baseline characteristics, neurological symptoms, and neurological signs were collected and compared between patients with acute strokes and stroke mimics.

Results: A total of 209 patients (66.77%) were true acute strokes and 104 patients (33.23%) were stroke mimics. Hypertension, Type 2 Diabetes Mellitus, and Atrial fibrillation were more frequently observed in true acute strokes, while a history of epilepsy and psychiatric disorder were more frequently observed in stroke mimics. Dysarthria, hemiparesis, and facial asymmetry, were significant predictors of a true stroke diagnosis. While symptoms of seizure like movements, sensory deficits in one arm or one leg, and loss of consciousness were significantly associated with stroke mimics.

Conclusions: This study highlights the high prevalence of stroke mimics in code stroke activations and reinforces the diagnostic value of key neurologic signs and symptoms that are associated with a true stroke. Incorporating evidence-based screening tools like FAST into stroke pathways may help reduce mimic cases and ease the burden on hospital resources.