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BackgroundWe aimed to determine the proportion of patients who had suffered a stroke and compare this to those patients with suspected stroke, and the range of differential diagnosis for suspected stroke.MethodsWe searched for prospective studies of suspected stroke in electronic databases and our personal files. We undertook a meta-analysis of these studies, aimed at determining the proportions of patients with confirmed stroke in different settings.ResultsWe identified 29 studies involving 8,839 patients: 13 studies were from emergency departments, five from stroke units or transient ischaemic attack (TIA) clinics, three from primary care, three from ambulance services and five were unspecified. About three-quarters (74% [95% confidence interval (CI): 66 to 83%]) of patients had a diagnosis of stroke, though there was significant heterogeneity in this estimate. The five most frequent non-stroke diagnoses were seizure, syncope, sepsis, migraine and brain tumours.ConclusionPatients who had not had a stroke accounted for a significant proportion of people referred to stroke services. Expertise in the differential diagnoses of stroke is needed in order to manage the patients at the point of referral.

Original publication




Journal article


The journal of the Royal College of Physicians of Edinburgh

Publication Date





114 - 118


Department of Clinical Radiology, Western General Hospital, Edinburgh EH4 2XU, UK.


Humans, Diagnosis, Differential, Clinical Competence, Health Facilities, Health Services Needs and Demand, Referral and Consultation, Primary Health Care, Stroke