Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke
Predictive Value of Modifications of the Prehospital Rapid Arterial Occlusion Evaluation Scale for Large Vessel Occlusion in Patients with Acute Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.08.032
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发表时间：
2017-01-01
影响因子：
2.5
通讯作者：
Perez de la Ossa, Natalia
中科院分区：
文献类型：
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作者：
Carrera, David;Campbell, Bruce C. V.;Perez de la Ossa, Natalia
背景：需要院前临床量表来识别急性卒中合并大血管闭塞（LVO）患者，并指导他们到血管内功能卒中中心。我们评估了快速动脉闭塞评估（RACE）量表的简化是否可以保持其识别LVO患者的高性能，RACE量表是一个先前在该领域验证的5项量表。方法：使用RACE量表的原始前瞻性验证队列，设计7个更简单版本的RACE量表，并对每位患者进行回顾性重新计算。在医院评估美国国立卫生研究院卒中量表评分和近端LVO。对简化版进行接收机工作特性分析，测试其识别LVO的性能。对于每个版本，使用敏感度最接近原始量表（85%）的阈值，并评估特异性和正确分类的变化。结果：纳入341例疑似脑卒中患者；20%有LVO。由于在选择的灵敏度水平上特异性较低，7种更简单的RACE量表在检测LVO的曲线下面积略低。面瘫简化或眼球或凝视偏离去除后，分类正确率下降9%，失语或失认症皮质征去除后，分类正确率下降4.5%。结论：我们推荐最初的RACE量表用于疑似卒中患者的院前评估，因为它易于使用，并且在预测LVO的存在方面性能良好。使用简化版本会降低其预测价值。
Background: Prehospital clinical scales to identify patients with acute stroke with a large vessel occlusion (LVO) and direct them to an endovascular-capable stroke center are needed. We evaluated whether simplification of the Rapid Arterial oCclusion Evaluation (RACE) scale, a 5-item scale previously validated in the field, could maintain its high performance to identify patients with LVO. Methods: Using the original prospective validation cohort of the RACE scale, 7 simpler versions of the RACE scale were designed and retrospectively recalculated for each patient. National Institutes of Health Stroke Scale score and proximal LVO were evaluated in hospital. Receiver operating characteristic analysis was performed to test performance of the simplified versions to identify LVO. For each version, the threshold with sensitivity closest to the original scale (85%) was used, and the variation in specificity and correct classification were assessed. Results: The study included 341 patients with suspected stroke; 20% had LVO. The 7 simpler versions of the RACE scale had slightly lower area under the curve for detecting LVO because of lower specificity at the chosen sensitivity level. Correct classification rate decreased 9% if facial palsy was simplified or if eye or gaze deviation was removed, and decreased 4.5% if the aphasia or agnosia cortical sign was removed. Conclusions: We recommend the original RACE scale for prehospital assessment of patients with suspected stroke for its ease of use and its high performance to predict the presence of a LVO. The use of simplified versions would reduce its predictive value.