TY - JOUR
T1 - Cost burden of stroke mimics and transient ischemic attack after intravenous tissue plasminogen activator treatment
AU - Goyal, Nitin
AU - Male, Shailesh
AU - Al Wafai, Ameer
AU - Bellamkonda, Sushma
AU - Zand, Ramin
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background: Treatment decisions for patients with acute stroke symptoms are based on pertinent history, neurologic examination, laboratory studies, and head computed tomography. In this setting, patients with stroke mimic (SM) may mistakenly receive intravenous tissue plasminogen activator (IV-rtPA). The goal of this study was to investigate the excess direct/indirect hospital costs among patients who received IV-rtPA when final diagnosis was not ischemic stroke. Methods: We reviewed the records of 535 IV-rtPA-treated patients who presented to our primary stroke centers. The diagnosis of SM or transient ischemic attack (TIA) was based on patient presentation, hospital course, electroencephalography, and negative neuroimaging studies. The excess cost analysis compared actual direct and indirect hospital costs of a patient to what their direct and indirect hospital costs would have been had they primarily been diagnosed with mimic or TIA. Results: Seventy-four patients post-IV-rtPA treatment had final diagnosis of SM; 21 had TIAs. The excess direct and indirect hospital costs for mimics were $257,975 and $152,813, respectively. The median excess cost was $5401 per admission. The excess total cost for TIAs was $85,026 with a median of $3407 per admission. Conclusions: Administration of IV-rtPA to patients with SMs remains prevalent and costly. Certain clinical or radiographic characteristics can help diagnose mimics; however, more studies need to be done to determine the feasibility and effectiveness of further clinical investigations among suspected SM patients who are within the thrombolysis treatment window.
AB - Background: Treatment decisions for patients with acute stroke symptoms are based on pertinent history, neurologic examination, laboratory studies, and head computed tomography. In this setting, patients with stroke mimic (SM) may mistakenly receive intravenous tissue plasminogen activator (IV-rtPA). The goal of this study was to investigate the excess direct/indirect hospital costs among patients who received IV-rtPA when final diagnosis was not ischemic stroke. Methods: We reviewed the records of 535 IV-rtPA-treated patients who presented to our primary stroke centers. The diagnosis of SM or transient ischemic attack (TIA) was based on patient presentation, hospital course, electroencephalography, and negative neuroimaging studies. The excess cost analysis compared actual direct and indirect hospital costs of a patient to what their direct and indirect hospital costs would have been had they primarily been diagnosed with mimic or TIA. Results: Seventy-four patients post-IV-rtPA treatment had final diagnosis of SM; 21 had TIAs. The excess direct and indirect hospital costs for mimics were $257,975 and $152,813, respectively. The median excess cost was $5401 per admission. The excess total cost for TIAs was $85,026 with a median of $3407 per admission. Conclusions: Administration of IV-rtPA to patients with SMs remains prevalent and costly. Certain clinical or radiographic characteristics can help diagnose mimics; however, more studies need to be done to determine the feasibility and effectiveness of further clinical investigations among suspected SM patients who are within the thrombolysis treatment window.
KW - Cost burden
KW - Intravenous thrombolysis
KW - Stroke
KW - Stroke mimics
KW - TIA
UR - http://www.scopus.com/inward/record.url?scp=84933279229&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84933279229&partnerID=8YFLogxK
U2 - 10.1016/j.jstrokecerebrovasdis.2014.11.023
DO - 10.1016/j.jstrokecerebrovasdis.2014.11.023
M3 - Article
C2 - 25735708
AN - SCOPUS:84933279229
SN - 1052-3057
VL - 24
SP - 828
EP - 833
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 4
ER -