Clinical Predictors of Accurate Prehospital Stroke Recognition
Clinical Predictors of Accurate Prehospital Stroke Recognition
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DOI：
10.1161/strokeaha.115.008650
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发表时间：
2015-06-01
期刊：
影响因子：
8.3
通讯作者：
Reeves, Mathew J.
中科院分区：
文献类型：
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作者：
Oostema, J. Adam;Konen, John;Reeves, Mathew J.
背景和目的——院前激活院内卒中反应可加速治疗，但依赖于准确的紧急医疗服务 (EMS) 卒中识别。我们试图测量 EMS 中风识别的准确性，并确定与正确中风识别相关的临床因素。方法 - 使用 EMS 和医院记录，我们收集了一组由 EMS 转运的疑似、确诊或漏诊的缺血性中风或短暂性脑缺血发作病例。使用出院诊断作为金标准计算 EMS 卒中识别的敏感性和阳性预测值 (PPV)。我们使用多变量逻辑回归分析来确定辛辛那提院前卒中量表的使用与 EMS 卒中识别之间的关联。 结果 - 在 12 个月期间，招募了 441 名 EMS 转运患者；其中，371 例（84.1%）为 EMS 疑似中风，70 例（15.9%）为 EMS 漏诊中风。总体而言，264 例 (59.9%) 被确诊为缺血性中风 (n=186) 或短暂性脑缺血发作 (n=78)。 EMS卒中识别的敏感性为73.5%（95%置信区间，67.7-78.7），PPV为52.3%（95%置信区间，47.1-57.5）。灵敏度（84.7% 对比 30.9%；P
Background and Purpose-Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification.Methods-Using EMS and hospital records, we assembled a cohort of EMS-transported suspect, confirmed, or missed ischemic stroke or transient ischemic attack cases. The sensitivity and positive predictive value (PPV) for EMS stroke recognition were calculated using the hospital discharge diagnosis as the gold standard. We used multivariable logistic regression analysis to determine the association between Cincinnati Prehospital Stroke Scale use and EMS stroke recognition.Results-During a 12-month period, 441 EMS-transported patients were enrolled; of which, 371 (84.1%) were EMS-suspected strokes and 70 (15.9%) were EMS-missed strokes. Overall, 264 cases (59.9%) were confirmed as either ischemic stroke (n=186) or transient ischemic attack (n=78). The sensitivity of EMS stroke recognition was 73.5% (95% confidence interval, 67.7-78.7), and PPV was 52.3% (95% confidence interval, 47.1-57.5). Sensitivity (84.7% versus 30.9%; P