Introduction: Diagnostic uncertainty results in admission and unnecessary treatment of stroke mimics (SMs), leading to substantial expenditure of limited existing resources. We investigated the costs of admitting SMs compared to the cost of MR imaging in the acute setting. Methods: In this retrospective cross-sectional study, we analyzed all suspected stroke admissions from January 2016 until July 2018. We evaluated the costs of admission of SMs to the stroke unit and compared it with the cost assumption of having performed MR instead of CT imaging in all patients who presented with stroke symptoms. Findings: A total of 1745 patients presenting with stroke symptoms was included. 1108 (63%) were diagnosed as ischemic strokes, 321 (18%) with intracranial haemorrhage and 316 (18%) with SMs. The calculated cost of the initial neuroimaging studies for all patients was A$631,291. The cost of performing MRI for these patients would have been A$657,167. Accordingly, the excess cost of performing MRI instead of CT scan in the acute setting would have been A$25,876.00. This is significantly lower than the costs of stroke admission of SMs (A$1,255,373). Conclusion: Unnecessary admission and stroke investigations for SM patients can impose huge expenses on health care system. Since MRI is highly sensitive and specific in diagnosis of acute stroke, utilizing it as the first imaging modality in diagnosis of acute stroke would reduce the cost of stroke admission of SMs.
Ehsan Esmaili Shandiz, Carin Bertmar, Susan Day, Dayna Griffiths, Elizabeth O’ Brien and Martin Krause