Iguchi Yasuyuki, Kimura Kazumi, Shibazaki Kensaku, Sakamoto Yuki, Sakai Kenichiro, Fujii Shuichi, Uemura Junichi
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Japan.
Cerebrovasc Dis Extra. 2011 Jan-Dec;1(1):28-35. doi: 10.1159/000327154. Epub 2011 Apr 14.
Our aim was to confirm the clinical relationship between the Kurashiki Prehospital Stroke Scale (KPSS) scored by paramedics and favorable outcomes in patients with modified Rankin scale (mRS) scores of 0-1 assessed 3 months after symptom onset.
We enrolled patients with acute stroke and transient ischemic attack showing symptoms on admission. Paramedics transferred patients to our hospital after estimating stroke severity using the KPSS. After categorizing patients into either the mRS 0-1 group (favorable outcome) or the mRS 2-6 group (no favorable outcome), we compared the background data between the two groups. We assessed KPSS scores predictive of a favorable outcome. Multivariate regression modeling was conducted to identify factors independently associated with a favorable outcome.
The study cohort comprised 147 patients with a premorbid status of mRS 0-1: 69 patients (47%) of them were in the mRS 0-1 group and 78 (53%) in the mRS 2-6 group at the follow-up 3 months after symptom onset. The median KPSS score was lower in the mRS 0-1 group than in the mRS 2-6 group (1 vs. 4, p < 0.001). After classifying the 147 patients into KPSS tertiles with thresholds of 2 and 4, the frequency of mRS 0-1 gradually decreased with increasing KPSS score (lower KPSS, 67.2%; middle KPSS, 47.6%, and higher KPSS, 21.3%; p < 0.001). KPSS score <3 was able to predict a favorable outcome with 67% sensitivity and 71% specificity, and independently associated with mRS 0-1 (odds ratio, 3.0; 95% confidence interval, 1.2-7.3; p = 0.015).
KPSS score <3 apparently presents a reasonable cutoff for predicting a favorable outcome in patients with acute cerebral ischemia.
我们的目的是证实急救人员使用仓敷院前卒中量表（KPSS）评分与症状发作3个月后改良Rankin量表（mRS）评分为0 - 1的患者良好预后之间的临床关系。
我们纳入了入院时出现症状的急性卒中和短暂性脑缺血发作患者。急救人员使用KPSS评估卒中严重程度后将患者转至我院。在将患者分为mRS 0 - 1组（良好预后）或mRS 2 - 6组（无良好预后）后，我们比较了两组之间的背景数据。我们评估了预测良好预后的KPSS评分。进行多变量回归建模以确定与良好预后独立相关的因素。
研究队列包括147例病前mRS为0 - 1的患者：症状发作后3个月随访时，其中69例（47%）在mRS 0 - 1组，78例（53%）在mRS 2 - 6组。mRS 0 - 1组的KPSS评分中位数低于mRS 2 - 6组（1对4，p < 0.001）。将147例患者按KPSS三分位数分类，阈值为2和4，随着KPSS评分升高，mRS 0 - 1的频率逐渐降低（低KPSS，67.2%；中KPSS，47.6%，高KPSS，21.3%；p < 0.001）。KPSS评分<3能够以67%的敏感性和71%的特异性预测良好预后，且与mRS 0 - 1独立相关（优势比，3.0；95%置信区间，1.2 - 7.3；p = 0.015）。
KPSS评分<3显然是预测急性脑缺血患者良好预后的合理界值。
