title: Utility of point of care assessment of platelet reactivity (using the PFA-100®) to aid in diagnosis of stroke.
abstract: BACKGROUND
  Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic.
  
  
  METHODS
  This prospective study included patients with symptoms of AIS treated at an inner-city emergency department (ED). Blood samples were obtained and assayed for platelet reactivity (quantified by closure time). Patients were grouped by discharge diagnosis into: AIS, TIA, or stroke mimic. Binary logistic regression model was used to predict the association of closure time with the final diagnosis of 1) either AIS or TIA or, 2) stroke mimic.
  
  
  RESULTS
  Of 114 patients enrolled, 32 were diagnosed with AIS, 33 TIA, and 49 were diagnosed as a stroke mimic. There was no significant difference in closure times among patients with a diagnosis of AIS or TIA versus stroke mimic. A history of migraines and history of seizures were independently associated with lower odds of an AIS or TIA diagnosis (OR 0.31, 95% CI 0.10 to 0.94 and OR 0.08, 95% CI 0.01 to 0.88, respectively).
  
  
  CONCLUSIONS
  Closure time was not found to be a clinically reliable differentiator of patients with a diagnosis of AIS, TIA, or stroke mimic in the ED.
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: cpearson@med.wayne.edu.
authors.forename: Claire
authors.initials: C
authors.lastname: Pearson
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Karin
authors.initials: K
authors.lastname: Przyklenk
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Valerie H
authors.initials: VH
authors.lastname: Mika
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Syed Imran
authors.initials: SI
authors.lastname: Ayaz
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Ellis
authors.affiliation: Department of Neurology/Neurocritical Care, Lehigh Valley Physician Group, Allentown, PA, USA.
authors.forename: Preet
authors.initials: P
authors.lastname: Varade
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Rosa
authors.initials: R
authors.lastname: Tolomello
authors.affiliation: Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, USA; Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation; D010979:Platelet Function Tests / Q000295:instrumentation*; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis*; D055815:Young Adult
keywords: Cerebrovascular event; Platelet function analyzer; Point-of-care testing