Derivation and Validation of the Emergency Medical Stroke Assessment and Comparison of Large Vessel Occlusion Scales
Derivation and Validation of the Emergency Medical Stroke Assessment and Comparison of Large Vessel Occlusion Scales
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DOI：
10.1016/j.jstrokecerebrovasdis.2017.10.018
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发表时间：
2018-03-01
影响因子：
2.5
通讯作者：
Levine, Steven R.
中科院分区：
文献类型：
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作者：
Gropen, Toby I.;Boehme, Amelia;Levine, Steven R.
背景：这项研究旨在开发一种简单的量表来识别院前卒中合并大血管闭塞(LVO)的患者，而不会失去对其他卒中类型的敏感性。方法：紧急医学卒中评估(EMSA)来源于美国国立卫生研究院卒中评定量表(NIHSS)，并在一个单独的队列中验证其对LVO的预测作用。我们将EMSA与卒中三项量表(3I-SS)、辛辛那提院前卒中严重程度量表(C-STAT)、快速动脉闭塞评估(RACE)量表和急诊目的地卒中现场评估分类(FAST-ED)进行比较，以预测LVO和卒中。我们对护理人员进行了调查，以评估量表的易用性和解释。结果：眼球偏爱、面部不对称、臂腿不对称漂移、言语或语言异常等因素共同导致EMSA。与3I-SS<4(.866，.798-0.926)相比，EMSA<3.75%的敏感性和50%的特异性显著降低了左心室关闭不全的可能性(LR=.489，95%可信区间366-0.637)。与3I-SS(.476，.330-0.688)和C-STAT(.858，.717-1.028)相比，EMSA正常、93%的敏感性和47%的特异性显著降低了中风的可能性(LR-=.142，.068-0.299)。72%(13/18)的护理人员认为EMSA易于执行，而FAST-ED组为67%(12/18)，RACE为6%(1/18)(chi(2)=27.25，P<；.0001)，易于解释的比例为94%(17/18)，FAST-ED组为56%(10/18)，RACE(chi(2)=21.13，P<；.0001)为11%(2/18)。结论：EMSA诊断LVO优于3I-SS和卒中，优于3I-SS和C-STAT。与FAST-ED和RACE相比，EMSA具有类似于对中风患者进行分类的能力，但更易于执行和解释。
Background: This study aims to develop a simple scale to identify patients with prehospital stroke with large vessel occlusion (LVO), without losing sensitivity for other stroke types. Methods: The Emergency Medical Stroke Assessment (EMSA) was derived from the National Institutes of Health Stroke Scale (NIHSS) items and validated for prediction of LVO in a separate cohort. We compared the EMSA with the 3-item stroke scale (3I-SS), Cincinnati Prehospital Stroke Severity Scale (C-STAT), Rapid Arterial oCclusion Evaluation (RACE) scale, and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) for prediction of LVO and stroke. We surveyed paramedics to assess ease of use and interpretation of scales. Results: The combination of gaze preference, facial asymmetry, asymmetrical arm and leg drift, and abnormal speech or language yielded the EMSA. An EMSA less than 3, 75% sensitivity, and 50% specificity significantly reduced the likelihood of LVO (LR- = .489, 95% confidence interval 366-0.637) versus 3I-SS less than 4 (.866, .798-0.926). A normal EMSA, 93% sensitivity, and 47% specificity significantly reduced the likelihood of stroke (LR- = .142, .068-0.299) versus 3I-SS (.476, .330-0.688) and C-STAT (.858, .717-1.028). EMSA was rated easy to perform by 72% (13 of 18) of paramedics versus 67% (12 of 18) for FAST-ED and 6% (1 of 18) for RACE (chi(2) = 27.25, P < .0001), and easy to interpret by 94% (17 of 18) versus 56% (10 of 18) for FAST-ED and 11% (2 of 18) for RACE (chi(2) = 21.13, P < .0001). Conclusions: The EMSA has superior abilities to identify LVO versus 3I-SS and stroke versus 3I-SS and C-STAT. The EMSA has similar ability to triage patients with stroke compared with the FAST-ED and RACE, but is simpler to perform and interpret.