Large vessel occlusion prediction scales provide high negative but low positive predictive values in prehospital suspected stroke patients.
Large vessel occlusion prediction scales provide high negative but low positive predictive values in prehospital suspected stroke patients.
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DOI：
10.1136/bmjno-2022-000272
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发表时间：
2022
影响因子：
2.7
通讯作者：
Madhok, Debbie Y.
中科院分区：
文献类型：
--
作者：
Keenan, Kevin J.;Smith, Wade S.;Cole, Sara B.;Martin, Christine;Hemphill, J. Claude;Madhok, Debbie Y.
关键词：
我们研究了一项急诊医疗系统（EMS）登记研究，该登记研究确定了院前疑似卒中患者，这些患者被送往具有血管内治疗能力的学术医院超过1年，以评估疾病的患病率，并对大血管闭塞（LVO）卒中预测量表进行外部验证，重点是预测值。所有患者的最后一次健康时间均在6小时内，院前辛辛那提院前卒中量表阳性。LVO预测量表评分是根据急诊到达美国国立卫生研究院卒中量表评分进行回顾性计算的。通过病历审查确定最终诊断。计算患病率和诊断性能统计。我们预先设定分析，以确定阳性预测值（PPV）≥80%和阴性预测值（NPV）≥ 95%的量表阈值。次要分析确定了PPV ≥ 50%的阈值。在220例EMS转运患者中，13.6%患有LVO卒中，15.9%患有颅内出血，20.5%患有非LVO卒中，50%患有卒中疑似诊断。在184例诊断性能研究合格患者中，LVO卒中患病率为15.8%。只有紧急目的地现场评估卒中分类（FAST-ED）≥7的PPV ≥ 80%，但该阈值遗漏了83%的LVO卒中。FAST-ED ≥6、院前急性严重程度量表=3和快速动脉闭塞评价≥7的PPV ≥50%，但敏感性<50%。一些标准和较低的替代量表阈值达到NPV ≥ 95%，但假阳性很常见。LVO预测量表的诊断性能权衡限制了其在不遗漏大多数LVO卒中的情况下实现高PPV的能力。多个尺度提供了高NPV阈值，但这些与许多假阳性相关。
We studied a registry of Emergency Medical Systems (EMS) identified prehospital suspected stroke patients brought to an academic endovascular capable hospital over 1 year to assess the prevalence of disease and externally validate large vessel occlusion (LVO) stroke prediction scales with a focus on predictive values. All patients had last known well times within 6 hours and a positive prehospital Cincinnati Prehospital Stroke Scale. LVO prediction scale scores were retrospectively calculated from emergency department arrival National Institutes of Health Stroke Scale scores. Final diagnoses were determined by chart review. Prevalence and diagnostic performance statistics were calculated. We prespecified analyses to identify scale thresholds with positive predictive values (PPVs) ≥80% and negative predictive values (NPVs) ≥95%. A secondary analysis identified thresholds with PPVs ≥50%. Of 220 EMS transported patients, 13.6% had LVO stroke, 15.9% had intracranial haemorrhage, 20.5% had non-LVO stroke and 50% had stroke mimic diagnoses. LVO stroke prevalence was 15.8% among the 184 diagnostic performance study eligible patients. Only Field Assessment Stroke Triage for Emergency Destination (FAST-ED) ≥7 had a PPV ≥80%, but this threshold missed 83% of LVO strokes. FAST-ED ≥6, Prehospital Acute Severity Scale =3 and Rapid Arterial oCclusion Evaluation ≥7 had PPVs ≥50% but sensitivities were <50%. Several standard and lower alternative scale thresholds achieved NPVs ≥95%, but false positives were common. Diagnostic performance tradeoffs of LVO prediction scales limited their ability to achieve high PPVs without missing most LVO strokes. Multiple scales provided high NPV thresholds, but these were associated with many false positives.
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