Vanni Simone, Polidori Gianluca, Pepe Giuseppe, Chiarlone Melisenda, Albani Alberto, Pagnanelli Adolfo, Grifoni Stefano
Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Emerg Med. 2011 May;40(5):499-505. doi: 10.1016/j.jemermed.2008.09.028. Epub 2009 Feb 13.
The absence of a rapidly available and sensitive diagnostic test represents an important limitation in the triage of patients with suspected stroke.
The aim of the present study was to investigate the triage accuracy of a novel test that measures blood-borne biomarkers (triage stroke panel, TSP) and to compare its accuracy with that of the Cincinnati Prehospital Stroke Scale (CPSS).
Consecutive patients with suspected stroke presenting to the Emergency Departments of three Italian hospitals underwent triage by a trained nurse according to the CPSS and had blood drawn for TSP testing. The TSP simultaneously measures four markers (B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100β) presenting a single composite result, the Multimarker Index (MMX). Stroke diagnosis was established by an expert committee blinded to MMX and CPSS results.
There were 155 patients enrolled, 87 (56%) of whom had a final diagnosis of stroke. The area under the receiver operating characteristic (ROC) curve for CPSS was 0.77 (95% confidence interval [CI] 0.70-0.84) and that of MMX was 0.74 (95% CI 0.66-0.82) (p = 0.285). Thus, both tests, when used alone, failed to recognize approximately 25% of strokes. The area under the ROC curve of the combination of the two tests (0.86, 95% CI 0.79-0.91) was significantly greater than that of either single test (p = 0.01 vs. CPSS and p < 0.001 vs. TSP).
In an emergency care setting, a panel test using multiple biochemical markers showed triage accuracy similar to that of CPSS. Further studies are needed before biomarkers can be introduced in the clinical work-up of patients with suspected stroke.
缺乏快速可用且灵敏的诊断测试是疑似中风患者分诊工作中的一个重要限制因素。
本研究旨在调查一种用于测量血液中生物标志物的新型测试（分诊中风检测组套，TSP）的分诊准确性，并将其准确性与辛辛那提院前中风量表（CPSS）进行比较。
连续入住三家意大利医院急诊科的疑似中风患者由一名经过培训的护士根据CPSS进行分诊，并抽取血液进行TSP测试。TSP同时测量四种标志物（B型利钠肽、D-二聚体、基质金属蛋白酶-9和S100β），得出一个单一的综合结果，即多标志物指数（MMX）。中风诊断由一个对MMX和CPSS结果不知情的专家委员会确定。
共纳入155例患者，其中87例（56%）最终诊断为中风。CPSS的受试者操作特征（ROC）曲线下面积为0.77（95%置信区间[CI]0.70 - 0.84），MMX的为0.74（95%CI 0.66 - 0.82）（p = 0.285）。因此，两种测试单独使用时均未能识别出约25%的中风病例。两种测试联合使用时的ROC曲线下面积（0.86，95%CI 0.79 - 0.91）显著大于任何一种单一测试（与CPSS相比p = 0.01，与TSP相比p < 0.001）。
在急诊护理环境中，使用多种生化标志物的组套测试显示出与CPSS相似的分诊准确性。在将生物标志物引入疑似中风患者的临床检查之前，还需要进一步研究。
