title: The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke Network.
abstract: BACKGROUND
  Up to 30% of acute stroke evaluations are deemed stroke mimics (SM). As telestroke consultation expands across the world, increasing numbers of SM patients are likely being evaluated via Telestroke. We developed a model to prospectively identify ischemic SMs during Telestroke evaluation.
  
  
  RESULTS
  We analyzed 829 consecutive patients from January 2004 to April 2013 in our internal New England-based Partners TeleStroke Network for a derivation cohort, and 332 cases for internal validation. External validation was performed on 226 cases from January 2008 to August 2012 in the Partners National TeleStroke Network. A predictive score was developed using stepwise logistic regression, and its performance was assessed using receiver-operating characteristic (ROC) curve analysis. There were 23% SM in the derivation, 24% in the internal, and 22% in external validation cohorts based on final clinical diagnosis. Compared to those with ischemic cerebrovascular disease (iCVD), SM had lower mean age, fewer vascular risk factors, more frequent prior seizure, and a different profile of presenting symptoms. The TeleStroke Mimic Score (TM-Score) was based on factors independently associated with SM status including age, medical history (atrial fibrillation, hypertension, seizures), facial weakness, and National Institutes of Health Stroke Scale >14. The TM-Score performed well on ROC curve analysis (derivation cohort AUC=0.75, internal validation AUC=0.71, external validation AUC=0.77).
  
  
  CONCLUSIONS
  SMs differ substantially from their iCVD counterparts in their vascular risk profiles and other characteristics. Decision-support tools based on predictive models, such as our TM Score, may help clinicians consider alternate diagnosis and potentially detect SMs during complex, time-critical telestroke evaluations.
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
authors: Syed F
authors: SF
authors: Ali
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
authors: Anand
authors: A
authors: Viswanathan
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
authors: Aneesh B
authors: AB
authors: Singhal
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
authors: Natalia S
authors: NS
authors: Rost
authors: INTEGRIS Health, Oklahoma City, OK (P.G.F., L.W.D.).
authors: Pamela G
authors: PG
authors: Forducey
authors: INTEGRIS Health, Oklahoma City, OK (P.G.F., L.W.D.).
authors: Lawrence W
authors: LW
authors: Davis
authors: Yale-New Haven Stroke Center, New Haven, CT (J.S.).
authors: Joseph
authors: J
authors: Schindler
authors: Swedish Medical Center, Seattle, WA (W.L., S.S.).
authors: William
authors: W
authors: Likosky
authors: Swedish Medical Center, Seattle, WA (W.L., S.S.).
authors: Sherene
authors: S
authors: Schlegel
authors: University of Virginia, Charlottesville, VA (N.S.).
authors: Nina
authors: N
authors: Solenski
authors: Massachusetts General Hospital/Harvard Medical School, Boston, MA (S.F.A., A.V., A.B.S., N.S.R., L.H.S.).
authors: Lee H
authors: LH
authors: Schwamm
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011446:Prospective Studies; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis*; D017216:Telemedicine / Q000379:methods*
keywords: cerebrovascular disease; stroke mimics; telestroke; thrombolysis