A new algorithm for suspected stroke patient management with NT-proBNP POCT platform in the emergency department: A new algorithm for suspected stroke patient

Introduction: Stroke is a leading cause of mortality and morbidity in China. Of the different subtypes of ischemic stroke, cardioembolic stroke is of particular importance because it is potentially preventable. This study aimed to evaluate the usefulness of measuring N-terminal pro-brain natriuretic peptide in the emergency department in early recognition of patients with cardioembolic stroke. Methods: This was a multicenter prospective cohort study conducted from 1 June 2015 to 30 June 2016 in four emergency departments. Adult patients with acute ischemic stroke were recruited. Plasma N-terminal pro-brain natriuretic peptide was measured in the emergency department. Discharge diagnosis was determined by neurologists according to the Trial of ORG 10172 in Acute Stroke Treatment criteria. The diagnostic performance of N-terminal probrain natriuretic peptide was assessed by measuring the sensitivity, specificity, receiver operating characteristic curve, and the area under curve. Results: In all, 258 patients were analyzed. Of them, 17.9% were diagnosed with cardioembolic stroke. The optimal cut-off concentration, sensitivity, specificity, and the area under the curve of the plasma N-terminal pro-brain natriuretic peptide concentration suitable to distinguish cardioembolic stroke from other subtypes of stroke were 501.2 pg/mL, 82.6%, 80.2%, and 0.87 (95% confidence interval: 0.83-0.92), respectively. Conclusion: Emergency physicians should strongly consider cardioembolic stroke in patients presented with acute ischemic stroke with an N-terminal pro-brain natriuretic peptide level over 501.2 pg/mL. However, it must be considered in context with clinical assessment and judgment before making treatment decisions.