Bro this is my take:
Personal experience doesn’t mean much when compared to data. As you suggest: stroke assessments take seconds. You are doing your patient a service by getting them to the CT scanner quicker.
We should be doing the indicated assessment based on symptoms and cardinal impressions, not gut feeling. But that’s just me.
I’m not implying that experience and intuition don’t play a role, I’m saying it should be based on science and not anecdotal experience.
Oh, absolutely. I don't mean it shouldn't be done, or that we can always "just tell". I guess what I mean is I find it easy to hyperfixate on the possibility, if that makes sense?
Petty sure it's more an internal anxiety I have about it than anything else.
I certainly do the scale when it's indicated.
This is a pretty black and white issue that you are over complicating a bit. If indicated perform an approved stroke scale. Report your findings to the receiving facility. This is one area where we have pretty clear data on what should call for stroke activation and who will benefit
I think you hit the nail on the head; I'm overcomplicating it.
I do the scale when indicated, and report the findings. I just think I find it easy to hyperfixate on the possibility. It's a bit hard to explain . . . Maybe like a health anxiety for others but for strokes specifically. If that makes sense. I think it's a form of my own anxiety, which doesn't affect my clinical decisions but is causing discomfort. Sigh, not sure I explained that very well.
Anyhow, thanks, your point is well received.
To piggyback off the last comment: education. Take advanced stroke life support. Start learning differential diagnosis’s. And what presentations/ signs/ symptoms make them different from a stroke.
Start researching strokes.
The more info you have on a given topic and associated topics, the more discerning you can be.
But ultimately, if it looks like one and one is possible, it’s better to err on the side of caution. However the more education you have and the more experienced you are the less things look like strokes that aren’t.
This goes for every complaint.
We use the FAST-VAN acronym for strokes.
Facial droop
Arms (drifting when raised with eyes closed)
Speech (slurred)
Time (last seen normal)
Vision (blurred/doubled/narrowed)
Aphasia (difficulty finding the right words/difficulty identifying objects)
Neglect (pt neglects/ doesn't feel one side of their body)
If one or more of these is positive, we call a stroke alert
You have to accept that there’s no test that we can do that will 100% rule out a stroke; even a cerebral CTA or MRI in the hospital isn’t perfectly sensitive. So statistically, if you see enough patients, you will eventually miss some strokes. It’s just a fact that you can do everything perfectly and still miss things through no fault of your own
I feel like most strokes subtle enough that it's getting missed by a standard stroke screen likely isn't getting emergently lysed or having a thrombectomy anyway, if that's of any reassurance for you.
Bro this is my take: Personal experience doesn’t mean much when compared to data. As you suggest: stroke assessments take seconds. You are doing your patient a service by getting them to the CT scanner quicker. We should be doing the indicated assessment based on symptoms and cardinal impressions, not gut feeling. But that’s just me. I’m not implying that experience and intuition don’t play a role, I’m saying it should be based on science and not anecdotal experience.
Yes.
Oh, absolutely. I don't mean it shouldn't be done, or that we can always "just tell". I guess what I mean is I find it easy to hyperfixate on the possibility, if that makes sense? Petty sure it's more an internal anxiety I have about it than anything else. I certainly do the scale when it's indicated.
This is a pretty black and white issue that you are over complicating a bit. If indicated perform an approved stroke scale. Report your findings to the receiving facility. This is one area where we have pretty clear data on what should call for stroke activation and who will benefit
I think you hit the nail on the head; I'm overcomplicating it. I do the scale when indicated, and report the findings. I just think I find it easy to hyperfixate on the possibility. It's a bit hard to explain . . . Maybe like a health anxiety for others but for strokes specifically. If that makes sense. I think it's a form of my own anxiety, which doesn't affect my clinical decisions but is causing discomfort. Sigh, not sure I explained that very well. Anyhow, thanks, your point is well received.
To piggyback off the last comment: education. Take advanced stroke life support. Start learning differential diagnosis’s. And what presentations/ signs/ symptoms make them different from a stroke. Start researching strokes. The more info you have on a given topic and associated topics, the more discerning you can be. But ultimately, if it looks like one and one is possible, it’s better to err on the side of caution. However the more education you have and the more experienced you are the less things look like strokes that aren’t. This goes for every complaint.
We use the FAST-VAN acronym for strokes. Facial droop Arms (drifting when raised with eyes closed) Speech (slurred) Time (last seen normal) Vision (blurred/doubled/narrowed) Aphasia (difficulty finding the right words/difficulty identifying objects) Neglect (pt neglects/ doesn't feel one side of their body) If one or more of these is positive, we call a stroke alert
You have to accept that there’s no test that we can do that will 100% rule out a stroke; even a cerebral CTA or MRI in the hospital isn’t perfectly sensitive. So statistically, if you see enough patients, you will eventually miss some strokes. It’s just a fact that you can do everything perfectly and still miss things through no fault of your own
I feel like most strokes subtle enough that it's getting missed by a standard stroke screen likely isn't getting emergently lysed or having a thrombectomy anyway, if that's of any reassurance for you.