Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes.
Field Assessment Stroke Triage for Emergency Destination: A Simple and Accurate Prehospital Scale to Detect Large Vessel Occlusion Strokes.
复制标题
DOI：
10.1161/strokeaha.116.013301
复制
发表时间：
2016-08
期刊：
影响因子：
8.3
通讯作者：
Nogueira RG
中科院分区：
文献类型：
--
作者：
Lima FO;Silva GS;Furie KL;Frankel MR;Lev MH;Camargo ÉC;Haussen DC;Singhal AB;Koroshetz WJ;Smith WS;Nogueira RG
大血管闭塞性中风（LVOS）患者可以通过直接转移到具有血管内治疗能力的中心获得更好的服务，避免初级和综合中风中心之间的危险延误。然而，准确的卒中现场分类仍然具有挑战性。我们的目标是开发一个简单的现场量表来识别 LVOS。 FAST-ED量表基于对LVOS具有较高预测价值的NIHSS项目，并在STOPStroke队列中进行测试，其中患者在中风发作的前24小时内接受CT血管造影。 LVOS 的定义是涉及颅内 ICA、MCA-M1、MCA-2 或基底动脉的完全闭塞。部分、双半球和/或前+后循环闭塞的患者被排除在外。将FAST-ED的受试者工作特征（ROC）曲线、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）与NIHSS、快速动脉闭塞评估（RACE）量表和辛辛那提院前卒中严重程度量表（CPSSS）进行比较。 727 名符合条件的患者中，有 240 名 (33%) 检测到 LVO。 FAST-ED 预测 LVO 的准确度与 NIHSS 相当，并且比 RACE 和 CPSS 具有更高的准确度（ROC 曲线下面积：FAST-ED=0.81 作为参考；NIHSS=0.80，p=0.28；RACE=0.77，p=0.02；CPSS=0.75，p=0.002）。 FAST-ED ≥4 的敏感性为 0.60，特异性为 0.89，PPV 0.72 和 NPV 0.82，而 RACE ≥5 的敏感性分别为 0.55、0.87、0.68、0.79，CPSS ≥2 的敏感性分别为 0.56、0.85、0.65、0.78。 FAST-ED 是一种简单的量表，如果在现场成功验证，医疗急救专业人员可以使用该量表在院前环境中识别 LVOS，从而实现对患者的快速分类。
Patients with large vessel occlusion strokes (LVOS) may be better served by direct transfer to endovascular capable centers avoiding hazardous delays between primary and comprehensive stroke centers. However, accurate stroke field triage remains challenging. We aimed to develop a simple field scale to identify LVOS. The FAST-ED scale was based on items of the NIHSS with higher predictive value for LVOS and tested in the STOPStroke cohort, in which patients underwent CT angiography within the first 24 hours of stroke onset. LVOS were defined by total occlusions involving the intracranial-ICA, MCA-M1, MCA-2, or basilar arteries. Patients with partial, bi-hemispheric, and/or anterior + posterior circulation occlusions were excluded. Receiver operating characteristic (ROC) curve, sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of FAST-ED were compared with the NIHSS, Rapid Arterial oCclusion Evaluation (RACE) scale and Cincinnati Prehospital Stroke Severity Scale (CPSSS). LVO was detected in 240 of the 727 qualifying patients (33%). FAST-ED had comparable accuracy to predict LVO to the NIHSS and higher accuracy than RACE and CPSS (area under the ROC curve: FAST-ED=0.81 as reference; NIHSS=0.80, p=0.28; RACE=0.77, p=0.02; and CPSS=0.75, p=0.002). A FAST-ED ≥4 had sensitivity of 0.60, specificity 0.89, PPV 0.72, and NPV 0.82 versus RACE ≥5 of 0.55, 0.87, 0.68, 0.79 and CPSS ≥2 of 0.56, 0.85, 0.65, 0.78, respectively. FAST-ED is a simple scale that if successfully validated in the field may be used by medical emergency professionals to identify LVOS in the pre-hospital setting enabling rapid triage of patients.