Objective:

To apply the FABS score for the identification of stroke mimics (SM) among emergency department (ED) stroke code activations at Bellevue Hospital (BH), a large municipal hospital.

Background:

Roughly one out of five acute stroke presentations are SM. FABS, a scoring tool for stratifying SM in the emergency setting, includes 6 variables: absent facial droop, absent history of atrial fibrillation, age <50 years, SBP <150 mmHg, seizure history, and isolated sensory symptoms without weakness. In the original study, a FABS score ≥3 identified SM with 90% sensitivity and 91% specificity.

Design/Methods:

We retrospectively analyzed consecutive patients presenting within 6 hours from stroke symptom onset at BH (February-July 2024). Inclusion criteria were: age>18 and activation of stroke code. Neurovascular events (NVE) included ischemic and hemorrhagic strokes, TIA, and RCVS. SM were determined by lack of acute infarct or hemorrhage on CT or MR, and based on the final documented diagnosis in the neurology attending note.

Results:

162 patients were included in the study; 41 (25.3%) were NVE and 121 (74.7%) were SM. Fifteen (36.6%) patients with NVE and 85 (70.2%) SM had FABS≥ 3 (p-value<0.05). Patients with FABS≥3 were more likely to be SM than patients with FABS<3 (OR 4, 95% CI [2.0-8.8]). Adding headache on presentation as a variable (HFABS) captured more SM; Sixteen (39.0%) patients with NVE and 93 (76.9%) SM had HFABS≥ 3 (p-value <0.05).

Conclusions:

The FABS score is a promising screening tool to identify SM in the ED at BH, a high volume municipal hospital with a diverse patient population where stroke codes are mostly run by trainees. The implementation of the FABS score at Bellevue could reduce the number of stroke codes, improve trainee burnout, and optimize the use of radiographic tests.