External validation of prehospital stroke scales for emergent large vessel occlusion

Notice ABSOLUTELY NOTHING on what to do with these strokes to get to 100% recovery. USELESS!

External validation of prehospital stroke scales for emergent large vessel occlusion

• Yu-Chen Chiu, MD
• Ming-Ju Hsieh, MD, PhD
• Yen-Heng Lin, MD
• 
  
• Chung-Wei Lee, MD
• Yu-Ching Lee, PhD
• Jiann-Shing Jeng, MD, PhD
• Show all authors

Published:December 11, 2020DOI:https://doi.org/10.1016/j.ajem.2020.12.011

Abstract

Background

It is suggested that a prehospital scale should be utilized to identify patients with emergent large vessel occlusion (ELVO). We aimed to perform external validation of nine ELVO scales.

Methods

This single center retrospective observational study included patients with ischemic stroke visiting the emergency department (ED) within 6 h of symptom onset. Participants were excluded if individual items of the National Institute of Health Stroke Scale scores were not recorded or they did not receive brain computed tomography angiography or magnetic resonance imaging before intravenous thrombolysis or endovascular thrombectomy, and within 24 h of ED admission. The first definition of ELVO was emergent occlusion of the internal carotid artery (ICA) and middle cerebral artery segment 1 (M1). The second definition was emergent occlusion of ICA, M1, basilar artery, middle cerebral artery segment 2, anterior cerebral artery segment 1, and posterior cerebral artery segment 1. Area under the receiver operating characteristic curve (AUROC) was constructed to examine discrimination. The sensitivity, specificity, positive predictive value, and negative predictive value of the nine scales under the two ELVO definitions were calculated.

Results

A total of 1231 patients were included in the study. No significant differences were observed in the AUROC under the two ELVO definitions. However, sensitivity values of these scales were largely different, ranging from 44.56% to 93.68% under the first ELVO definition. The sensitivity values among scales were also different under the second ELVO definition.

Conclusion

Stakeholders in the community should choose suitable scales according to their own system conditions.

Keywords

• Stroke
• Emergency medical service
• Emergent large vessel occlusion
• Prediction

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