Prehospital stroke detection scales: A head-to-head comparison of 7 scales in patients with suspected stroke.

Autor:	Dekker L; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands., Moudrous W; Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands.; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Daems JD; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Buist EF; Amsterdam University Medical Center, Amsterdam, The Netherlands., Venema E; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.; Department of Emergency Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Durieux MD; Emergency Medical Services Hollands-Midden, Leiden, The Netherlands., van Zwet EW; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands., de Schryver EL; Department of Neurology, Alrijne Hospital, Leiderdorp, The Netherlands., Kloos LM; Department of Neurology, Groene Hart Hospital, Gouda, The Netherlands., de Laat KF; Department of Neurology, Haga Hospital, The Hague, The Netherlands., Aerden LA; Department of Neurology, Reinier de Graaf Gasthuis Hospital, Delft, The Netherlands., Dippel DW; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Kerkhoff H; Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands., van den Wijngaard IR; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.; University NeuroVascular Center (UNVC), Leiden-The Hague, The Netherlands., Wermer MJ; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; University NeuroVascular Center (UNVC), Leiden-The Hague, The Netherlands.; Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands., Roozenbeek B; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands., Kruyt ND; Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.; University NeuroVascular Center (UNVC), Leiden-The Hague, The Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2024 Sep 10, pp. 17474930241275123. Date of Electronic Publication: 2024 Sep 10.
DOI:	10.1177/17474930241275123
Abstrakt:	Background: Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking. Aims: To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients. Methods: We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale. Results: We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%). Conclusions: Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: N.D.K. reported receiving Grant HA20 15.01.02 from the Dutch Brain Foundation, Grant 3.240 from the Dutch Innovation Funds, and Grant LSHM16041 from Health~Holland during the conduct of the study, paid to the institution. B.R. reported funding from the Dutch Heart Foundation and the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of this study, paid to the institution. M.J.H.W. reported receiving Clinical Established Investigator Grant 2016T086 from the Dutch Heart Foundation and VIDI Grant 9171337 from the Netherlands Organization for Health Research and Development (ZonMw) during the conduct of the original LPSS study. D.W.J.D. reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health~Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to the institution outside the submitted work. I.R.W. reports compensation from Philips and from Medtronic for consultant services, and stock holdings in Neurophyxia BV. All other authors report no conflicting interests.
Databáze:	MEDLINE
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