Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

After you have determined this, what are the EXACT PROTOCOLS FOR 100% RECOVERY? This is totally incomplete research, in my job I'd be fired in no time for not doing a thorough job, dotting the i's and crossing the t's.

Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion

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Yanqi Shao*, Zheyu Zhang*, Bo Jin, ...

First Published June 30, 2022 Research Article 

https://doi.org/10.1177/17562864221104511

Article information

Abstract

Background:

Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment.(Your tyranny of low expectations is showing.)

Objective:

This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population.

Methods:

This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis.

Results:

A total of 400 patients were included in this analysis. In the training group (n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group (n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 (p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778).

Conclusion:

The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.

Keywords

acute stroke, China, large vessel occlusion, retrospective study

Introduction

Stroke was the leading cause of disability-adjusted life years (DALYs) in 2017 and ranked third among the leading causes of death in China.¹ Ischemic stroke accounts for 79.1% of all strokes in China.² As stroke is a time-dependent disease, the benefit of treatment is highly influenced by the rapid recognition of stroke, especially for those with a large vessel occlusion (LVO).

Many stroke screening tools, that is, the FAST scale (Face-Arm-Speech-Time, which is equivalent to Stroke 1-2-0 test in China),^3,4 are derived from the National Institute of Health Stroke Scale (NIHSS). When the NIHSS score ⩾ 6, LVO is suspected.⁵ Therefore, the degree of neurological deficits shown on the NIHSS can reflect both the diagnosis and the severity of stroke. However, these stroke-screening tools have obvious limitations in clinical practice mainly due to two problems. First, there are no reliable tools applied that screen for both stroke and LVO simultaneously during prehospital triage stage. As a result, emergency medicine services (EMS) paramedics use separate scales to detect stroke and LVO during prehospital triage. This increases the burden and complexity of their training and daily work. Second, there are still disputes about which items in the NIHSS are suitable to construct a quality prehospital prediction scale.^6,7 Although existing screening scales have become increasingly simplified for ease of application, this may sacrifice the sensitivity or specificity of detection. Furthermore, EMS paramedics could utilize information such as medical history to aid in detection of stroke and LVO; however, whether medical history can improve the detection of stroke and LVO is currently unknown.

This study aimed to develop and validate a scale for predicting both stroke and LVO at the prehospital triage stage in an urban, Chinese population. We hypothesized that adding medical history would improve a scale’s predictive value compared with using clinical symptoms alone.

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