Abstract TP276: Comparative Performance of for Paramedic Stroke Severity Assessment Scales of Stroke Severity in Assessing Stroke Severity and Predicting Long-Term Functional Outcome
| Autor: | Nerses Sanossian, Jason McMullan, Kristina Shkirkova, Frank Pratt, David S Liebeskind, Scott Hamilton, Sidney Starkman, Shauna Chueng, Jeffrey L. Saver, Robin Conwit, Marc Eckstein |
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| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.tp276 |
| Popis: | Background: Brief prehospital stroke severity scales have several uses, but their comparative performance has generally been evaluated only in screening for patients likely harboring large vessel occlusion. An additional application is in providing a baseline deficit assessment to enable severity adjustment in clinical trials of prehospital stroke treatments. Objective: To assess the convergent, divergent, and predictive validity of LAMS, C-STAT, FAST-ED, and RACE for stroke severity and 90-day outcome (freedom from disability - mRS 0-1). Methods: We analyzed data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals. Results: Among 1632 acute cerebrovascular disease patients, (age was 69±13 years, female 42.6%, and final diagnoses were cerebral ischemia in 73.3% and intracranial hemorrhage in 22.8%. Time from onset to hospital arrival assessment was 145 minutes (IQR 119-180). Correlation with a concurrently performed, “gold standard” full hospital arrival NIHSS was: LAMS 0.89, FAST-ED 0.95, RACED 0.89, and C-STAT 0.89. All scales were divergent with a concurrently performed GCS. Predictive accuracy (C statistics) for excellent 3-month outcome among acute cerebrovascular disease patients was: hospital arrival LAMS 0.78 (95%CI 0.76-0.81); FAST-ED 0.80 (95%CI 0.78-0.82); RACE 0.79 (95%CI 0.77-0.82); C-STATS 0.77 (95%CI 0.75-0.80), among cerebral ischemia patients was: LAMS 0.75 (95%CI 0.72-0.78); FAST-ED 0.77 (95%CI 0.74-0.79); RACE 0.77 (0.74-0.79); C-STATS 0/74 (0.71-0.77), and among intracranial hemorrhage patients was: LAMS 0.81 (95%CI 0.73-0.89); FAST-ED 0.86 (95%CI 0.81-0.92); RACE 0.82 (95%CI 0.75-0.91); C-STATS 0.83 (95%CI 0.78-0.90). Conclusions: The four brief stroke severity measures, LAMS, C-STAT, FAST-ED, and RACE, showed comparable, moderate to excellent, convergent, divergent, and predictive validity in assessing stroke severity and forecasting long-term outcome, further supporting their appropriateness for use by prehospital personnel. |
| Databáze: | OpenAIRE |
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