Coffman Clarity R, Raman Rema, Ernstrom Karin, Herial Nabeel A, Schlick Konrad H, Rapp Karen, Modir Royya F, Meyer Dawn M, Hemmen Thomas M, Meyer Brett C
Department of Neurosciences, University of California, San Diego, California.
Department of Family and Preventive Medicine, University of California, San Diego, California.
J Stroke Cerebrovasc Dis. 2015 Jun;24(6):1299-304. doi: 10.1016/j.jstrokecerebrovasdis.2015.01.040. Epub 2015 Apr 16.
Rapid diagnosis in stroke is critical. Computed tomography is often performed initially, even before a neurologic examination. Gaze deviation has been correlated with stroke diagnosis in some cohorts. Conjugate gaze deviation on stroke code imaging, the "DeyeCOM sign," may have emergency stroke care implications.
We evaluated stroke code imaging from the University of California, San Diego database (2007-2013) for "DeyeCOM sign" diagnostic and predictive utility. Patients were grouped as DeyeCOM+ if conjugate gaze deviation was noted. The differences were assessed using the Fisher exact test for categorical and the Wilcoxon rank-sum test for continuous variables.
We evaluated 342 patients; 106 (31%) were DeyeCOM+. Mean age was 63. The most common diagnoses in the DeyeCOM+ group were ischemic stroke (50.94%), transient ischemic attack (8.49%), other (8.49%), somatization (6.6%), and hemorrhage (5.66%). The National Institutes of Health Stroke Scale was greater in stroke patients than that in nonstroke (8.2 versus 3.8; P < .0001), and in DeyeCOM+ compared with DeyeCOM- (6.8 versus 5.6; P = .03). DeyeCOM+ patients were more likely to have a +gaze score (26.4% versus 9.8%; P < .0001), and +gaze patients were more likely to have final stroke diagnosis (26.0% versus 3.6%; P < .0001). There was no overall difference between groups in final stroke diagnosis; however, patients with deviation of 15° or more were more likely to have final diagnosis stroke (63.9% versus 47.9%; P = .03).
DeyeCOM+ patients scored higher and were more likely to have +gaze on the stroke scale, and deviation of 15° or more was correlated with final diagnosis stroke. In current environments, there is pressure to complete stroke evaluations rapidly. Reliable imaging information obtained early (such as gaze deviation on scan correlating with scale score and final stroke diagnosis) could augment decision making even with negative imaging.
卒中的快速诊断至关重要。计算机断层扫描通常在进行神经系统检查之前就首先进行。在一些队列研究中，凝视偏斜与卒中诊断相关。卒中编码成像上的共轭凝视偏斜，即“DeyeCOM征”，可能对紧急卒中治疗有影响。
我们评估了加利福尼亚大学圣地亚哥分校数据库（2007 - 2013年）中的卒中编码成像，以确定“DeyeCOM征”的诊断和预测效用。如果观察到共轭凝视偏斜，患者被归为DeyeCOM+组。使用Fisher精确检验评估分类变量的差异，使用Wilcoxon秩和检验评估连续变量的差异。
我们评估了342例患者；106例（31%）为DeyeCOM+组。平均年龄为63岁。DeyeCOM+组中最常见的诊断为缺血性卒中（50.94%）、短暂性脑缺血发作（8.49%）、其他（8.49%）、躯体化障碍（6.6%）和出血（5.66%）。国立卫生研究院卒中量表评分在卒中患者中高于非卒中患者（8.2对3.8；P <.0001），在DeyeCOM+组中高于DeyeCOM-组（6.8对5.6；P = 0.03）。DeyeCOM+组患者更有可能有凝视评分阳性（26.4%对9.8%；P <.0001），而凝视评分阳性的患者更有可能最终被诊断为卒中（26.0%对3.6%；P <.0001）。两组在最终卒中诊断上没有总体差异；然而，偏斜15°或更大的患者更有可能最终被诊断为卒中（63.9%对47.9%；P = 0.03）。
DeyeCOM+组患者评分更高，在卒中量表上更有可能有凝视评分阳性，偏斜15°或更大与最终卒中诊断相关。在当前环境下，快速完成卒中评估存在压力。早期获得的可靠成像信息（如扫描时的凝视偏斜与量表评分及最终卒中诊断相关）即使在成像结果为阴性时也可能有助于决策。
