FABS: An Intuitive Tool for Screening of Stroke Mimics in the Emergency Department

Nitin Goyal, Georgios Tsivgoulis, Shailesh Male, E. Jeffrey Metter, Sulaiman Iftikhar, Ali Kerro, Jason J. Chang, James L. Frey, Sokratis Triantafyllou, Georgios Papadimitropoulos, Vida Abedi, Anne W. Alexandrov, Andrei V. Alexandrov, Ramin Zand

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Background and Purpose - A large number of patients with symptoms of acute cerebral ischemia are stroke mimics (SMs). In this study, we sought to develop a scoring system (FABS) for screening and stratifying SM from acute cerebral ischemia and to identify patients who may require magnetic resonance imaging to confirm or refute a diagnosis of stroke in the emergency setting. Methods - We designed a scoring system: FABS (6 variables with 1 point for each variable present): absence of Facial droop, negative history of Atrial fibrillation, Age <50 years, systolic Blood pressure <150 mm Hg at presentation, history of Seizures, and isolated Sensory symptoms without weakness at presentation. We evaluated consecutive patients with symptoms of acute cerebral ischemia and a negative head computed tomography for any acute finding within 4.5 hours after symptom onset in 2 tertiary care stroke centers for validation of FABS. Results - A total of 784 patients (41% SMs) were evaluated. Receiver operating characteristic curve (C statistic, 0.95; 95% confidence interval [CI], 0.93-0.98) indicated that FABS≥3 could identify patients with SM with 90% sensitivity (95% CI, 86%-93%) and 91% specificity (95% CI, 88%-93%). The negative predictive value and positive predictive value were 93% (95% CI, 90%-95%) and 87% (95% CI, 83%-91%), respectively. Conclusions - FABS seems to be reliable in stratifying SM from acute cerebral ischemia cases among patients in whom the head computed tomography was negative for any acute findings. It can help clinicians consider advanced imaging for further diagnosis.

Original languageEnglish (US)
Pages (from-to)2216-2220
Number of pages5
Issue number9
StatePublished - Sep 1 2016

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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