急诊科卒中模拟病：疑似急性卒中患者的患病率、病因及临床预测因素
Stroke mimics in the emergency department: Prevalence, etiologies, and clinical predictors in patients with suspected acute stroke.
文献信息
| PMID | 42933219 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Thanat Tangpaisarn |
| 作者单位 | Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address: thantan@kku.ac.th. |
| 期刊 | The American journal of emergency medicine |
| SCI 分区 | Q2 |
| IF | 2.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 卒中模拟病表现为类似卒中的急性神经系统症状，仍是急诊科（ED）的主要诊断挑战。早期与真性卒中鉴别对于及时治疗和合理利用资源十分重要。
目的： 确定在症状发作9小时内因疑似急性卒中就诊于急诊科的患者中卒中模拟病的患病率、病因及临床预测因素。
方法： 我们开展了一项回顾性队列研究，纳入2021年1月至2024年12月期间在泰国Srinagarind医院急诊科就诊的成人。符合条件的患者年龄≥18岁，症状发作9小时内疑似急性卒中，并通过机构卒中快速通道方案进行分诊。从电子病历中提取人口学特征、合并症、就诊症状、体格检查结果和神经影像学结果。最终诊断由主治神经科医师确定。采用单因素和多因素logistic回归分析识别与卒中模拟病独立相关的因素。
结果： 在1615例患者中，347例（21.5%；95%置信区间[CI]，19.5-23.5%）被诊断为卒中模拟病。癫痫相关疾病是最常见病因（13.8%），其次为心血管和脑血管非卒中性疾病（11.2%）以及感染性或炎症性疾病（10.1%）。在多因素分析中，较年轻年龄、男性、偏头痛史、精神疾病和癫痫史，以及较低的舒张压和较高的心率与卒中模拟病独立相关。与卒中模拟病独立相关的就诊特征包括意识改变（校正比值比[aOR] 1.71；95% CI，1.25-2.33）、癫痫发作（aOR 2.68；95% CI，1.79-4.00）、眩晕（aOR 1.85；95% CI，1.28-2.65）和发热（aOR 3.10；95% CI，1.36-7.12）。相反，肢体无力和言语障碍与确诊卒中独立相关。
结论： 在急诊科疑似急性卒中就诊者中，卒中模拟病占21.5%。意识改变、癫痫发作、眩晕和发热与卒中模拟病独立相关，而肢体无力和言语障碍则支持确诊卒中。
英文摘要
BACKGROUND: Stroke mimics present with acute neurological symptoms resembling stroke and remain a major diagnostic challenge in the emergency department (ED). Early differentiation from true stroke is important for timely treatment and appropriate resource utilization.
OBJECTIVE: To determine the prevalence, etiologies, and clinical predictors of stroke mimics among patients presenting to the ED with suspected acute stroke within 9 h of symptom onset.
METHODS: We conducted a retrospective cohort study of adults who presented to the ED of Srinagarind Hospital, Thailand, between January 2021 and December 2024. Eligible patients were aged ≥18 years, had suspected acute stroke within 9 h of symptom onset, and were triaged through the institutional Stroke Fast-Track protocol. Demographic characteristics, comorbidities, presenting symptoms, physical examination findings, and neuroimaging results were extracted from electronic medical records. Attending neurologists determined the final diagnoses. Univariate and multivariable logistic regression analyses identified factors independently associated with stroke mimics.
RESULTS: Among 1615 patients, 347 (21.5%; 95% confidence interval [CI], 19.5-23.5%) were diagnosed with stroke mimics. Seizure-related disorders were the most common etiology (13.8%), followed by cardiovascular and cerebrovascular non-stroke conditions (11.2%) and infectious or inflammatory diseases (10.1%). In multivariable analysis, younger age, male sex, a history of migraine, psychiatric disorders, and epilepsy, along with lower diastolic blood pressure and higher heart rate, were independently associated with stroke mimics. Presenting features independently associated with stroke mimics included altered consciousness (adjusted odds ratio [aOR] 1.71; 95% CI, 1.25-2.33), seizure (aOR 2.68; 95% CI, 1.79-4.00), vertigo (aOR 1.85; 95% CI, 1.28-2.65), and fever (aOR 3.10; 95% CI, 1.36-7.12). Conversely, limb weakness and speech disturbance were independently associated with confirmed stroke.
CONCLUSION: Stroke mimics accounted for 21.5% of suspected acute stroke presentations in the ED. Altered consciousness, seizure, vertigo, and fever were independently associated with stroke mimics, whereas limb weakness and speech disturbance favored confirmed stroke.