Validação da escala Telestroke Mimic Score em uma coorte brasileira

Abstract

Acute ischemic stroke (AIS) is one of the leading causes of morbidity and mortality in Brazil. Its proper management, including the indication for intravenous thrombolysis or mechanical thrombectomy, depends on rapid and accurate diagnosis to achieve effective outcomes. Telemedicine has emerged as an efficient strategy to expand access to specialized neurological evaluation. However, a key challenge in this model of care is distinguishing AIS from other acute conditions that mimic it, known as stroke mimics. The Telestroke Mimic Score (TM-Score) was developed to assist in this differential diagnosis in telemedicine consultations. This study aimed to validate the TM-Score in a Brazilian cohort assessed via telemedicine, evaluating its applicability and diagnostic properties. A retrospective analysis was conducted on adult patients treated between January 2019 and December 2022 by a teleneurology network in Rio de Janeiro. Inclusion criteria encompassed patients with an initial suspicion of AIS or transient ischemic attack — diagnoses collectively referred to as ischemic cerebrovascular disease (ICVD) — raised by an emergency physician in a remote setting. The TM-Score demonstrated good performance in distinguishing AIS from SM, with an area under the ROC curve (AUC) of 0.755 (95% CI: 0.718–0.791), similar to original studies and validations in other populations. The mean score was 20.72 in the ICVD group and 14.36 in the stroke mimic group (OR = 1.18, 95% CI: 1.14 – 1.22; p < 0.001). Some variables showed different distributions compared to foreign cohorts, suggesting the need for adjustments to the score's coefficients for better adaptation to the Brazilian context. Scores <10 and >25 showed a high correlation with stroke mimics and ICVD, respectively. The stroke mimic rate (29.7%) was higher than previously reported, which may be related to differences in screening protocols and patient epidemiology. Seizures were the most common stroke mimic. These findings reinforce the TM-Score’s usefulness as a clinical decision-support tool in telemedicine, especially in emergency services without neurologists. Its implementation could streamline patient management, reduce unnecessary treatments for stroke mimics, and improve diagnostic accuracy. Future studies should explore possible adaptations of the score for the population.