FABS

An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department

Nitin Goyal, Georgios Tsivgoulis, Shailesh Male, E. Metter, Sulaiman Iftikhar, Ali Kerro, Jason J. Chang, James L. Frey, Sokratis Triantafyllou, Georgios Papadimitropoulos, Vida Abedi, Anne Alexandrov, Andrei Alexandrov, Ramin Zand

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Purpose - 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. Methods - 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. Results - 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. Conclusions - 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.

Original languageEnglish (US)
Pages (from-to)2216-2220
Number of pages5
JournalStroke
Volume47
Issue number9
DOIs
StatePublished - Sep 1 2016

Fingerprint

Hospital Emergency Service
Stroke
Brain Ischemia
Confidence Intervals
Head
Tomography
Blood Pressure
Tertiary Care Centers
ROC Curve
Atrial Fibrillation
Seizures
Emergencies
Magnetic Resonance Imaging

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

FABS : An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department. / Goyal, Nitin; Tsivgoulis, Georgios; Male, Shailesh; Metter, E.; Iftikhar, Sulaiman; Kerro, Ali; Chang, Jason J.; Frey, James L.; Triantafyllou, Sokratis; Papadimitropoulos, Georgios; Abedi, Vida; Alexandrov, Anne; Alexandrov, Andrei; Zand, Ramin.

In: Stroke, Vol. 47, No. 9, 01.09.2016, p. 2216-2220.

Research output: Contribution to journalArticle

Goyal, N, Tsivgoulis, G, Male, S, Metter, E, Iftikhar, S, Kerro, A, Chang, JJ, Frey, JL, Triantafyllou, S, Papadimitropoulos, G, Abedi, V, Alexandrov, A, Alexandrov, A & Zand, R 2016, 'FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department', Stroke, vol. 47, no. 9, pp. 2216-2220. https://doi.org/10.1161/STROKEAHA.116.013842
Goyal, Nitin ; Tsivgoulis, Georgios ; Male, Shailesh ; Metter, E. ; Iftikhar, Sulaiman ; Kerro, Ali ; Chang, Jason J. ; Frey, James L. ; Triantafyllou, Sokratis ; Papadimitropoulos, Georgios ; Abedi, Vida ; Alexandrov, Anne ; Alexandrov, Andrei ; Zand, Ramin. / FABS : An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department. In: Stroke. 2016 ; Vol. 47, No. 9. pp. 2216-2220.
@article{fc77fde6e5944ef3a7a9285c8ecb9434,
title = "FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department",
abstract = "Background and Purpose - 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. Methods - 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. Results - 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. Conclusions - 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.",
author = "Nitin Goyal and Georgios Tsivgoulis and Shailesh Male and E. Metter and Sulaiman Iftikhar and Ali Kerro and Chang, {Jason J.} and Frey, {James L.} and Sokratis Triantafyllou and Georgios Papadimitropoulos and Vida Abedi and Anne Alexandrov and Andrei Alexandrov and Ramin Zand",
year = "2016",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.116.013842",
language = "English (US)",
volume = "47",
pages = "2216--2220",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - FABS

T2 - An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Male, Shailesh

AU - Metter, E.

AU - Iftikhar, Sulaiman

AU - Kerro, Ali

AU - Chang, Jason J.

AU - Frey, James L.

AU - Triantafyllou, Sokratis

AU - Papadimitropoulos, Georgios

AU - Abedi, Vida

AU - Alexandrov, Anne

AU - Alexandrov, Andrei

AU - Zand, Ramin

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background and Purpose - 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. Methods - 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. Results - 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. Conclusions - 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.

AB - Background and Purpose - 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. Methods - 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. Results - 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. Conclusions - 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.

UR - http://www.scopus.com/inward/record.url?scp=84982843780&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982843780&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.116.013842

DO - 10.1161/STROKEAHA.116.013842

M3 - Article

VL - 47

SP - 2216

EP - 2220

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -