Implications of Hemisensory Stroke Symptoms in Patients Undergoing Emergency Evaluation for Chest Pain (P05.246)

OBJECTIVE: To validate the observation that emergency department (ED) evaluation of patients presenting with chest pain (CP) and hemisensory stroke symptoms (SS) is predictably negative. BACKGROUND: We informally observed that ED evaluation of patients presenting with CP and SS is always negative. DESIGN/METHODS: After IRB approval, we reviewed charts of patients presenting to our ED within the past 5 years with principal diagnosis of CP (ICD9: 786.5, 786.59) and secondary diagnosis of SS (782.0). RESULTS: Fifty five patients were identified. Evaluation was negative in all. Distinguishing features: arrived by personal vehicle (82%), young (median age 41). Minimal vascular risk (%): female (68), hypertension (38), diabetes (20), dyslipidemia (18), smoking (14), history of organic heart or brain disease (12, 16). CP unusual (%): chronic recurrent (90); mean duration 1.68 days; pain sharp (33), fluctuating (42); severity mild/moderate (89); accompanied by headache (34); unresponsive to treatment in ED (46); prior ED visits for CP (28). SS unusual (%): left sided (86), nonobjectifiable exam. All patients had negative EKG, enzymes, chest radiograph, head CT. Tests also negative for additional modalities (% tested): head and neck CTA (34); neurology consult (24); chest CT (18). Process times (mean minutes): brain imaging 35; chest CT 40; neurology consultation 50. Total ED = 5 hours, 41 minutes. Discharged home 70%. Admitted for observation 30%: negative stress testing, MRI brain scan, attending level consultation in all; median length of stay 2 days. CONCLUSIONS: In this single institution analysis of 55 patients, the co-presentation of CP and SS predicted negative evaluation for both complaints. Prospective validation of a profile of these patients could save costs of imaging and neurology consultation; substantially reduce total ED time; and eliminate the need and cost of hospitalization. Study of the presentation of chest pain associated with other neurological symptoms could prove to be of similar value. Supported by: The Robert and Ann Williams Stroke Research fund. Disclosure: Dr. Frey has received personal compensation for activities with Boehringer Ingelheim, Bristol Myers Squibb, EKT pharma, Genentech, and Sanofi-Aventis as a speakers bureau member. Dr. Darbonne has nothing to disclose. Dr. Saldivar has nothing to disclose. Dr. Saha has nothing to disclose. Dr. Clark has nothing to disclose. Dr. Chapple has nothing to disclose.