Prehospital scales predict large vessel occlusion in patients with acute ischemic stroke: a comparison of 10 scales
10.3760/cma.j.issn.1673-4165.2019.11.002
- VernacularTitle: 院前量表预测急性缺血性卒中患者的大血管闭塞：10种量表比较
- Author:
Shumin CHEN
1
;
Junming ZHOU
2
;
Guanghui LIU
1
;
Yongfang ZHANG
1
;
Ling LI
1
;
Haijun ZHANG
3
;
Liang ZHOU
1
Author Information
1. Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
2. Department of Continuing Education, the First People's Hospital of Foshan, Foshan 528000, China
3. Department of Neurology, Baoan District People's Hospital, Shenzhen 518101, China
- Publication Type:Clinical Trail
- Keywords:
Stroke;
Brain ischemia;
Severity of illness;
Arterial occlusive diseases;
Predictive value of tests;
Sensitivity and specificity
- From:
International Journal of Cerebrovascular Diseases
2019;27(11):807-813
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the predictive value of 10 prehospital assessment scales for large vessel occlusion in patients with acute ischemic stroke.
Methods:From January 2016 to December 2018, patients with acute ischemic stroke within 24 h of onset admitted to the Department of Neurology, Nanfang Hospital, Southern Medical University were enrolled retrospectively. The scores of various scales were calculated based on clinical data, including the National Institutes of Health Stroke Scale (NIHSS), Los Angeles Motor Scale (LAMS), and 3-item stroke scale (3I- SS), Prehospital Acute Stroke Severity Scale (PASS), Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST), and Stroke Vision, Aphasia, and Neglect Assessment Scales (VAN), etc. The predictive threshold of the NIHSS score was determined, and the receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the effectiveness of various prehospital scales to predict large vessel occlusion.
Results:A total of 705 patients with acute ischemic stroke within 24 h of onset were enrolled, including 252 (35.7%) with large vessel occlusion. The best predictive cutoff value for judging large vessel occlusion by the NIHSS score was 9, sensitivity was 81.7%, specificity was 79.7%, positive likelihood ratio was 4.851, and negative likelihood ratio was 0.260. LAMS score ≥4 (sensitivity 88.1%, specificity 81.0%, positive likelihood ratio 4.640, and negative likelihood ratio 0.247), VAN positive (sensitivity 83.7%, specificity 82.3%, positive likelihood ratio 4.741, and negative likelihood ratio 0.198) and NIHSS score ≥9 were more accurate in identifying large vessel occlusion. The AUC values of the 8 quantitative scores were all > 0.7, and the AUC of LAMS was the largest (0.852, 95% confidence interval 0.825-0.878).
Conclusions:In patients with acute ischemic stroke within 24 h of onset, the NIHSS score ≥9 can be used as the best cutoff value for predicting large vessel occlusion events. LAMS, VAN, and NIHSS scales are more accurate in predicting large vessel occlusion. The predictive power of the 8 quantitative scales is higher, and the AUC of LAMS is the largest, which can be used for clinical prediction of large vessel occlusion in patients with acute ischemic stroke.
