title: FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department.
abstract: A large number of patients with symptoms of acute cerebral ischemia are stroke mimics (SMs). In this study, we sought to develop a scoring system (FABS) for screening and stratifying SM from acute cerebral ischemia and to identify patients who may require magnetic resonance imaging to confirm or refute a diagnosis of stroke in the emergency setting.
  
  
  
  We designed a scoring system: FABS (6 variables with 1 point for each variable present): absence of Facial droop, negative history of Atrial fibrillation, Age <50 years, systolic Blood pressure <150 mm Hg at presentation, history of Seizures, and isolated Sensory symptoms without weakness at presentation. We evaluated consecutive patients with symptoms of acute cerebral ischemia and a negative head computed tomography for any acute finding within 4.5 hours after symptom onset in 2 tertiary care stroke centers for validation of FABS.
  
  
  
  A total of 784 patients (41% SMs) were evaluated. Receiver operating characteristic curve (C statistic, 0.95; 95% confidence interval [CI], 0.93-0.98) indicated that FABS≥3 could identify patients with SM with 90% sensitivity (95% CI, 86%-93%) and 91% specificity (95% CI, 88%-93%). The negative predictive value and positive predictive value were 93% (95% CI, 90%-95%) and 87% (95% CI, 83%-91%), respectively.
  
  
  
  FABS seems to be reliable in stratifying SM from acute cerebral ischemia cases among patients in whom the head computed tomography was negative for any acute findings. It can help clinicians consider advanced imaging for further diagnosis.
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Nitin
authors: N
authors: Goyal
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Georgios
authors: G
authors: Tsivgoulis
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Shailesh
authors: S
authors: Male
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: E Jeffrey
authors: EJ
authors: Metter
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Sulaiman
authors: S
authors: Iftikhar
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Ali
authors: A
authors: Kerro
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Jason J
authors: JJ
authors: Chang
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: James L
authors: JL
authors: Frey
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Sokratis
authors: S
authors: Triantafyllou
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Georgios
authors: G
authors: Papadimitropoulos
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Vida
authors: V
authors: Abedi
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Anne W
authors: AW
authors: Alexandrov
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.).
authors: Andrei V
authors: AV
authors: Alexandrov
authors: From the Department of Neurology, University of Tennessee Health Science Center, Memphis (N.G., G.T., S.M., E.J.M., S.I., A.K., J.J.C., A.W.A., A.V.A., R.Z.); Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Greece (G.T., S.T., G.P.); Department of Neurology, International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Department of Neurology, Barrow Neurological Institute, Phoenix, AZ (J.L.F.); and Department of Bioinformatics, Computational Biology and Systems Biology, Biocomplexity Institute, Virginia Tech, Blacksburg (V.A., R.Z.). rzand@uthsc.edu.
authors: Ramin
authors: R
authors: Zand
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging
keywords: atrial fibrillation; diagnosis; emergency service, hospital; scoring system; stroke