Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause
Background Patients with large vessel occlusion stroke (LVOS) need to be rapidly identified and transferred to comprehensive stroke centers. However, current prehospital evaluation and strategies still remain challenging. Methods and Results We retrospectively reviewed our prospectively collected da...
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doaj-bb650a6df9dc4a299064846f0be36d632021-09-07T18:11:47ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-09-01101710.1161/JAHA.121.021201Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its CauseJianan Wang0Xiaoxian Gong1Wansi Zhong2Ying Zhou3Min Lou4Department of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou ChinaDepartment of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou ChinaDepartment of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou ChinaDepartment of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou ChinaDepartment of Neurologythe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou ChinaBackground Patients with large vessel occlusion stroke (LVOS) need to be rapidly identified and transferred to comprehensive stroke centers. However, current prehospital evaluation and strategies still remain challenging. Methods and Results We retrospectively reviewed our prospectively collected database of patients with acute ischemic stroke (AIS). Based on the items of National Institutes of Health Stroke Scale and medical history that had a strong association with LVOS, we designed the 4‐item Stroke Scale (4I‐SS) and validated it in multi‐centers. The 4I‐SS incorporated gaze, level of consciousness, arm weakness, and atrial fibrillation. Receiver operating characteristic analysis was used to compare the 4I‐SS with previously established prehospital prediction scales. Finally, 1630 and 11 440 patients were included in the derivation and validation cohort, respectively. In the validation cohort, Youden Index, area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the 4I‐SS≥4 to predict LVOS were 0.494, 0.800, 0.657, 0.837, 0.600, 0.868, and 0.788, respectively, and that of the 4I‐SS≥7 to predict basilar artery occlusion were 0.200, 0.669, 0.229, 0.971, 0.066, 0.974, and 0.899, respectively. Youden Index and area under the curve were higher than previously published scales for predicting LVOS. Further analysis showed that for predicting whether cardiogenic embolism was the cause, its accuracy was 0.922 when the 4I‐SS score, including atrial fibrillation, was ≥6, and its accuracy of predicting the occluded vessel was intracranial internal carotid artery or M1 segment of the middle cerebral artery when it was ≥7 was 0.590. Conclusions The 4I‐SS is an effective and simple tool that can identify LVOS and its cause. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03317639.https://www.ahajournals.org/doi/10.1161/JAHA.121.0212014I‐SScardiogenic embolismLVOSNIHSS |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jianan Wang Xiaoxian Gong Wansi Zhong Ying Zhou Min Lou |
spellingShingle |
Jianan Wang Xiaoxian Gong Wansi Zhong Ying Zhou Min Lou Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 4I‐SS cardiogenic embolism LVOS NIHSS |
author_facet |
Jianan Wang Xiaoxian Gong Wansi Zhong Ying Zhou Min Lou |
author_sort |
Jianan Wang |
title |
Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause |
title_short |
Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause |
title_full |
Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause |
title_fullStr |
Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause |
title_full_unstemmed |
Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause |
title_sort |
novel prehospital triage scale for detecting large vessel occlusion and its cause |
publisher |
Wiley |
series |
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
issn |
2047-9980 |
publishDate |
2021-09-01 |
description |
Background Patients with large vessel occlusion stroke (LVOS) need to be rapidly identified and transferred to comprehensive stroke centers. However, current prehospital evaluation and strategies still remain challenging. Methods and Results We retrospectively reviewed our prospectively collected database of patients with acute ischemic stroke (AIS). Based on the items of National Institutes of Health Stroke Scale and medical history that had a strong association with LVOS, we designed the 4‐item Stroke Scale (4I‐SS) and validated it in multi‐centers. The 4I‐SS incorporated gaze, level of consciousness, arm weakness, and atrial fibrillation. Receiver operating characteristic analysis was used to compare the 4I‐SS with previously established prehospital prediction scales. Finally, 1630 and 11 440 patients were included in the derivation and validation cohort, respectively. In the validation cohort, Youden Index, area under the curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the 4I‐SS≥4 to predict LVOS were 0.494, 0.800, 0.657, 0.837, 0.600, 0.868, and 0.788, respectively, and that of the 4I‐SS≥7 to predict basilar artery occlusion were 0.200, 0.669, 0.229, 0.971, 0.066, 0.974, and 0.899, respectively. Youden Index and area under the curve were higher than previously published scales for predicting LVOS. Further analysis showed that for predicting whether cardiogenic embolism was the cause, its accuracy was 0.922 when the 4I‐SS score, including atrial fibrillation, was ≥6, and its accuracy of predicting the occluded vessel was intracranial internal carotid artery or M1 segment of the middle cerebral artery when it was ≥7 was 0.590. Conclusions The 4I‐SS is an effective and simple tool that can identify LVOS and its cause. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03317639. |
topic |
4I‐SS cardiogenic embolism LVOS NIHSS |
url |
https://www.ahajournals.org/doi/10.1161/JAHA.121.021201 |
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