Box Hill Hospital and Deakin University, Victoria, Australia.
Stroke. 2010 Jul;41(7):1363-6. doi: 10.1161/STROKEAHA.109.571836. Epub 2010 Jun 10.
Recent evidence suggests the Cincinnati Prehospital Stroke Scale is ineffectively used and lacks sensitivity and specificity. Melbourne (Australia) paramedics have been using the Melbourne Ambulance Stroke Screen (MASS) since 2005. The aim of this study was to review the real-world use of MASS 3 years after city wide implementation.
Two groups of consecutively admitted patients to an Australian hospital between January and May 2008 were used: (1) patients for whom paramedics performed MASS; and (2) patients with a discharge diagnosis of stroke or transient ischemic attack. Use of MASS was examined for all transports and for patients diagnosed with stroke or transient ischemic attack. The sensitivity and specificity of paramedic diagnosis, MASS, and Cincinnati Prehospital Stroke Scale were calculated. Paramedic diagnosis of stroke among patients with stroke was statistically compared with those obtained immediately post-MASS implementation in 2002.
For the study period, MASS was performed for 850 (16%) of 5286 emergency transports, including 199 of 207 (96%) patients with confirmed stroke and transient ischemic attack. In patients in whom MASS was performed (n=850), the sensitivity of paramedic diagnosis of stroke (93%, 95% CI: 88% to 96%) was higher than the MASS (83%, 95% CI: 77% to 88%, P=0.003) and equivalent to Cincinnati Prehospital Stroke Scale (88%, 95% CI: 83% to 92%, P=0.120), whereas the specificity of the paramedic diagnosis of stroke (87%, 95% CI: 84% to 89%) was equivalent to MASS (86%, 95% CI: 83% to 88%, P=0.687) and higher than Cincinnati Prehospital Stroke Scale (79%, 95% CI: 75% to 82%, P<0.001). The initial improvement in stroke paramedic diagnosis seen in 2002 (94%, 95% CI: 86% to 98%) was sustained in 2008 (89%, 95% CI: 84% to 94%, P=0.19).
In our experience, paramedics have successfully incorporated MASS into the assessment of neurologically compromised patients. The initial improvement to the paramedics' diagnosis of stroke with MASS was sustained 3 years after city wide implementation.
最近的证据表明，辛辛那提院前卒中量表的使用效果不佳，缺乏敏感性和特异性。自 2005 年以来，墨尔本（澳大利亚）的护理人员一直在使用墨尔本急救卒中筛查（MASS）。本研究的目的是在全市实施 3 年后，回顾 MASS 的实际应用情况。
使用澳大利亚医院 2008 年 1 月至 5 月间连续收治的两组患者：（1）护理人员进行 MASS 检查的患者；（2）出院诊断为卒中或短暂性脑缺血发作的患者。检查了所有转运患者和卒中或短暂性脑缺血发作患者的 MASS 使用情况。计算了护理人员诊断、MASS 和辛辛那提院前卒中量表的敏感性和特异性。对卒中患者的护理人员诊断与 2002 年 MASS 实施后即刻的诊断进行统计学比较。
在研究期间，MASS 用于 5286 次紧急转运中的 850 次（16%），包括 199 例确诊的卒中或短暂性脑缺血发作患者。在进行 MASS 的患者中（n=850），护理人员诊断卒中的敏感性（93%，95%CI：88%至 96%）高于 MASS（83%，95%CI：77%至 88%，P=0.003），与辛辛那提院前卒中量表相当（88%，95%CI：83%至 92%，P=0.120），而卒中护理人员诊断的特异性（87%，95%CI：84%至 89%）与 MASS 相当（86%，95%CI：83%至 88%，P=0.687），高于辛辛那提院前卒中量表（79%，95%CI：75%至 82%，P<0.001）。2002 年观察到的卒中护理人员诊断的初步改善（94%，95%CI：86%至 98%）在 2008 年得到了维持（89%，95%CI：84%至 94%，P=0.19）。
根据我们的经验，护理人员已经成功地将 MASS 纳入对神经功能受损患者的评估中。在全市实施 3 年后，MASS 对护理人员卒中诊断的初步改善仍在持续。
