{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:19:45Z","timestamp":1792685985275,"version":"4.5.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Early differential diagnosis between stroke mimics and cerebrovascular events is a major challenge in the Emergency Department (ED). The primary aim of this study was to identify diagnostic predictors of stroke mimics based on parameters acquired during the ED triage of patients with suspected stroke. Secondly, we aimed to develop a diagnostic score for early differential diagnosis. Moreover, we compared the diagnostic accuracy of our score with that of other two validated scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>We included consecutive patients presenting to the ED of an urban teaching hospital for suspected stroke from 2015 to 2022 in the retrospective derivation cohort and during 2023 in the prospective validation cohort. Cerebrovascular events predictors were identified by logistic regression and were used to develop the Stroke Mimics Score (SMS). The diagnostic performance of SMS was assessed using the area under the receiver operating characteristics curves (AUROC) and the comparison with other diagnostic scores (FABS \u2013 Facial droop, Atrial fibrillation, Age, Systolic blood pressure, Seizure, Sensory symptoms\u2013 and TMS\u2013 TeleStroke Mimic score) was performed through DeLong method and Net Reclassification Index (NRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>About 8648 patients were included in the study, 6998 in the retrospective cohort, and 1650 in the prospective cohort. In the retrospective cohort, 3266 (46.7%) patients had a final diagnosis of stroke mimic. Several variables collected by triage nurses independently predicted cerebrovascular event over stroke mimic diagnosis. The 10-variable SMS had excellent diagnostic performance in both the derivation and validation cohorts [AUROC 0.777 (95% CI: 0.766\u20130.788) and 0.774 (95% CI: 0.752\u20130.797), respectively] and outperformed FABS and TMS in all statistical comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion:<\/jats:title>\n                    <jats:p>Several clinical variables elicited by triage nurses in the ED help to differentiate cerebrovascular events from stroke mimics in suspected stroke patients. The SMS is an easy-to-use score that could help selecting the best pathway for such patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873251338654","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T01:24:41Z","timestamp":1747358681000},"page":"1462-1471","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["A novel stroke mimic prediction score during in-hospital triage for suspected stroke patients: The Stroke Mimics Score (SMS)"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2370-840X","authenticated-orcid":false,"given":"Irene","family":"Scala","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"},{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Covino","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart, Rome, Italy 2"},{"name":"Emergency Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5698-2336","authenticated-orcid":false,"given":"Pier Andrea","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"},{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Bisegna","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Marchese","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Bellavia","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8295-9271","authenticated-orcid":false,"given":"Aldobrando","family":"Broccolini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"},{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Di Iorio","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Della Marca","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"},{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Catholic University of Sacred Heart, Rome, Italy 2"},{"name":"Emergency Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Monforte","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Calabresi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"},{"name":"Catholic University of Sacred Heart, Rome, Italy 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Frisullo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"2026012115064362000_bibr1-23969873251338654","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1161\/CIRCRESAHA.116.308413","article-title":"Global burden of stroke","volume":"120","author":"Feigin","year":"2017","journal-title":"Circ Res"},{"key":"2026012115064362000_bibr2-23969873251338654","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1161\/CIRCULATIONAHA.123.064053","article-title":"Shorter door-to-needle times are associated with better outcomes after intravenous thrombolytic therapy and endovascular thrombectomy for acute ischemic stroke","volume":"148","author":"Man","year":"2023","journal-title":"Circulation"},{"key":"2026012115064362000_bibr3-23969873251338654","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1002\/ana.25546","article-title":"An intracerebral hemorrhage care bundle is associated with lower case fatality","volume":"86","author":"Parry-Jones","year":"2019","journal-title":"Ann Neurol"},{"key":"2026012115064362000_bibr4-23969873251338654","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1001\/jama.2020.25071","article-title":"Incidence of transient ischemic attack and association with long-term risk of stroke","volume":"325","author":"Lioutas","year":"2021","journal-title":"JAMA"},{"key":"2026012115064362000_bibr5-23969873251338654","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000005954","article-title":"Diagnosing cerebral ischemia with door-to-thrombolysis times below 20 minutes","volume":"91","author":"Pihlasviita","year":"2018","journal-title":"Neurology"},{"key":"2026012115064362000_bibr6-23969873251338654","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1161\/STROKEAHA.115.009012","article-title":"Safety of intravenous thrombolysis in stroke mimics: prospective 5-year study and comprehensive meta-analysis","volume":"46","author":"Tsivgoulis","year":"2015","journal-title":"Stroke"},{"key":"2026012115064362000_bibr7-23969873251338654","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1177\/17474930241275123","article-title":"Prehospital stroke detection scales: a head-to-head comparison of 7 scales in patients with suspected stroke","volume":"20","author":"Dekker","year":"2025","journal-title":"Int J Stroke"},{"key":"2026012115064362000_bibr8-23969873251338654","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1161\/01.STR.0000204041.13466.4c","article-title":"Distinguishing between stroke and mimic at the bedside: the brain attack study","volume":"37","author":"Hand","year":"2006","journal-title":"Stroke"},{"key":"2026012115064362000_bibr9-23969873251338654","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2024-088014","article-title":"Patient-reported symptoms and admission pathways in stroke mimics versus confirmed stroke or transient ischaemic attack: a cross-sectional observational study","volume":"15","author":"S\u00f8rensen","year":"2025","journal-title":"BMJ Open"},{"key":"2026012115064362000_bibr10-23969873251338654","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.STR.0000044170.46643.5E","article-title":"Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test","volume":"34","author":"Harbison","year":"2003","journal-title":"Stroke"},{"key":"2026012115064362000_bibr11-23969873251338654","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.114.000838","article-title":"The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a telestroke network","volume":"3","author":"Ali","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"2026012115064362000_bibr12-23969873251338654","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3109\/10903127.2013.773113","article-title":"Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency","volume":"17","author":"Studnek","year":"2013","journal-title":"Prehosp Emerg Care"},{"key":"2026012115064362000_bibr13-23969873251338654","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1161\/STROKEAHA.118.022130","article-title":"The 2CAN score","volume":"49","author":"Chang","year":"2018","journal-title":"Stroke"},{"key":"2026012115064362000_bibr14-23969873251338654","doi-asserted-by":"crossref","first-page":"2216","DOI":"10.1161\/STROKEAHA.116.013842","article-title":"FABS: an intuitive tool for screening of stroke mimics in the emergency department","volume":"47","author":"Goyal","year":"2016","journal-title":"Stroke"},{"key":"2026012115064362000_bibr15-23969873251338654","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/S1474-4422(05)70201-5","article-title":"The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument","volume":"4","author":"Nor","year":"2005","journal-title":"Lancet Neurol"},{"key":"2026012115064362000_bibr16-23969873251338654","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/1747493018806194","article-title":"Evaluation of a score for the prehospital distinction between cerebrovascular disease and stroke mimic patients","volume":"14","author":"Geisler","year":"2019","journal-title":"Int J Stroke"},{"key":"2026012115064362000_bibr17-23969873251338654","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"2026012115064362000_bibr18-23969873251338654","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/j.1365-2362.2011.02562.x","article-title":"Assessing the incremental value of diagnostic and prognostic markers: a review and illustration","volume":"42","author":"Steyerberg","year":"2012","journal-title":"Eur J Clin Invest"},{"key":"2026012115064362000_bibr19-23969873251338654","doi-asserted-by":"crossref","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.04.018","article-title":"Predictors of acute stroke mimics in 8187 patients referred to a stroke service","volume":"22","author":"Merino","year":"2013","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2026012115064362000_bibr20-23969873251338654","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1186\/s12883-020-01846-6","article-title":"External validation of stroke mimic prediction scales in the emergency department","volume":"20","author":"Tu","year":"2020","journal-title":"BMC Neurol"},{"key":"2026012115064362000_bibr21-23969873251338654","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/MEJ.0000000000000550","article-title":"The frequency, characteristics and aetiology of stroke mimic presentations: a narrative review","volume":"26","author":"McClelland","year":"2019","journal-title":"Eur J Emerg Med"},{"key":"2026012115064362000_bibr22-23969873251338654","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11910-017-0727-0","article-title":"Stroke Chameleons and stroke mimics in the emergency department","volume":"17","author":"Liberman","year":"2017","journal-title":"Curr Neurol Neurosci Rep"},{"key":"2026012115064362000_bibr23-23969873251338654","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1161\/STROKEAHA.111.000126","article-title":"Safety of thrombolysis in stroke mimics: results from a multicenter cohort study","volume":"44","author":"Zinkstok","year":"2013","journal-title":"Stroke"},{"key":"2026012115064362000_bibr24-23969873251338654","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1161\/STROKEAHA.118.022857","article-title":"Is the cost-effectiveness of stroke thrombolysis affected by proportion of stroke mimics?","volume":"50","author":"Liberman","year":"2019","journal-title":"Stroke"},{"key":"2026012115064362000_bibr25-23969873251338654","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1212\/WNL.0000000000004149","article-title":"Effects of increasing IV tPA-treated stroke mimic rates at CT-based centers on clinical outcomes","volume":"89","author":"Burton","year":"2017","journal-title":"Neurology"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23969873251338654","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23969873251338654","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/4\/1462\/65869533\/23969873251338654.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/4\/1462\/65869533\/23969873251338654.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:08:08Z","timestamp":1769026088000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/10\/4\/1462\/8377190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":25,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1177\/23969873251338654","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12,1]]},"published":{"date-parts":[[2025,12,1]]}}}