The Los Angeles Motor Scale as a predictor of angiographically determined large vessel occlusion
The Los Angeles Motor Scale as a predictor of angiographically determined large vessel occlusion
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DOI：
10.1007/s11739-019-02272-4
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发表时间：
2020-06-01
影响因子：
4.6
通讯作者：
Fiorella, David
中科院分区：
文献类型：
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作者：
Brandler, Ethan Samuel;Thode, Henry;Fiorella, David
用于治疗紧急大血管闭塞（ELVO）的时间敏感性机械血栓切除术的最新进展已经改变了院前提供者的角色，从简单地识别卒中到识别ELVO的可能存在。没有一种在现场识别ELVO的方法被证明是上级的。我们试图描述如何使用洛杉矶运动量表（LAMS）与护理人员和紧急医疗技术人员（EMT）的其他体检结果最好地完成这一点。我们让医护人员和急救人员检查医院里疑似中风的病人。我们将他们的检查结果与标准神经科医生的检查结果和血管造影结果进行了比较。我们进行了多项分析，以确定最能识别大血管闭塞的检查元素。使用阈值评分为4的LAMS，卒中和ELVO的敏感性分别为27%（95%CI 20-36%）和42%（95%CI 30-55%）。当LAMS为3时，与言语异常同时使用时，灵敏度提高至36%（95% CI 28-45%）和61%（95% CI 48-73%）。该模型的特异性为70%（95%CI 64-75%）。最引人注目的是该模型对ELVO的阴性预测值：90%（95% CI 85-93%）LAMS或LAMS加语音可用于减少漏诊大血管闭塞的数量，并将可疑的大血管闭塞送往有血栓切除术能力的中心。其他更复杂的尺度可能没有什么额外的好处。这个衍生数据集是第一个使用护理人员和EMT作为检查员的前瞻性和支持院前协议的变化正在纽约市。
Recent advances in time-sensitive mechanical thrombectomy for the treatment of emergent large vessel occlusion (ELVO) have changed the role of prehospital providers from simply identifying a stroke to identifying the likely presence of ELVO. No one method for identifying ELVO in the field has been demonstrated to be superior. We sought to describe how this might be best accomplished using the Los Angeles Motor Scale (LAMS) in concert with other physical exam findings by paramedics and emergency medical technicians (EMTs). We had paramedics and EMTs examine patients with suspected stroke in the hospital. We compared their exams to the standard neurologist exams and to the results of angiography. We performed multiple analyses to identify the exam elements that would best identify large vessel occlusions. Using LAMS with a threshold score of 4, sensitivity for stroke and ELVO, respectively, was 27% (95% CI 20-36%) and 42% (95% CI 30-55%). When a LAMS of 3 was used in concert with speech abnormality, sensitivity improved to 36% (95% CI 28-45%) and 61% (95% CI 48-73%). Specificity of this model was 70%, (95% CI 64-75%). Most striking was the negative predictive value of this model for ELVO: 90% (95% CI 85-93%) The LAMS or LAMS plus speech can be used to decrease the number of missed large vessel occlusions and to route suspected large vessel occlusions to thrombectomy-capable centers. Other, more complicated scales may have little additional benefit. This derivation data set is the first to use paramedics and EMTs as examiners prospectively and supports prehospital protocol change underway in New York City.