The only valid scale is a binary one as determined by the survivor. Are you fully recovered? Y/N? Anything else is just trying to justify complete fucking failures by your doctor, therapists and hospital!
Validating Existing Scales for Identification of Acute Stroke in an Inpatient Setting
Abstract
Background and Purpose
A
significant proportion of strokes occur while patients are hospitalized
for other reasons. Numerous stroke scales have been developed and
validated for use in pre-hospital and emergency department settings, and
there is growing interest to adapt these scales for use in the
inpatient setting. We aimed to validate existing stroke scales for
inpatient stroke codes.
Methods
We
retrospectively reviewed charts from inpatient stroke code activations
at an urban academic medical center from January 2016 through December
2018. Receiver operating characteristic analysis was performed for each
specified stroke scale including NIHSS, FAST, BE-FAST, 2CAN, FABS,
TeleStroke Mimic, and LAMS. We also used logistic regression to identify
independent predictors of stroke and to derive a novel scale.
Results
Of
the 958 stroke code activations reviewed, 151 (15.8%) had a final
diagnosis of ischemic or hemorrhagic stroke. The area under the curve
(AUC) of existing scales varied from .465 (FABS score) to .563 (2CAN
score). Four risk factors independently predicted stroke: (1) recent
cardiovascular procedure, (2) platelet count less than 50 × 109
per liter, (3) gaze deviation, and (4) presence of unilateral leg
weakness. Combining these 4 factors into a new score yielded an AUC of
.653 (95% confidence interval [CI] .604-.702).
Conclusion
This
study suggests that currently available stroke scales may not be
sufficient to differentiate strokes from mimics in the inpatient
setting. Our data suggest that novel approaches may be required to help
with diagnosis in this unique population.
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