Distinguishing stroke from mimics in telemedicine: How well does the TM-Score perform in a Brazilian telestroke network?

Abstract

BackgroundStroke is a leading cause of mortality and disability worldwide. In Brazil, ischemic strokes account for 85% of cases, but many hospitals lack resources for acute stroke care. Telestroke programs connect underserved hospitals to specialized centers, improving access to treatment. However, stroke mimics (SMs) pose a diagnostic challenge, potentially delaying appropriate management. The Telestroke Mimic Score (TM-Score) is a clinical tool designed to differentiate ischemic cerebrovascular disease (ICVD) from SM, but it has not been validated in South America. The objective of this study is to assess the validity of the TM-Score in distinguishing ICVD from SM in a Brazilian cohort.MethodsWe conducted a retrospective study using data from the Neurological Telemedicine Database of Hospital Pró-Cardíaco, Rio de Janeiro. Patients evaluated for suspected stroke via telemedicine (January 2019-December 2022) were classified as ICVD or SM by a telestroke neurologist. The TM-Score's performance was analyzed using receiver-operating characteristic (ROC) curves, sensitivity, specificity, and predictive values.ResultsAmong 777 patients (ICVD: 561, SM: 216), the mean TM-Score was significantly higher in ICVD (20.72 ± 6.86 vs 14.36 ± 5.73, p < 0.001). A score ≥25 had high specificity (96%) and PPV (95%) for ICVD, while <10 had an NPV of 0.71. The AUC was 0.755 (95% CI: 0.718-0.791).ConclusionThe TM-Score is a valuable tool for differentiating ICVD from SM in Brazil, supporting more accurate decision-making, particularly in telemedicine settings without stroke specialists.