Oostema J Adam, Konen John, Chassee Todd, Nasiri Mojdeh, Reeves Mathew J
From the Department of Emergency Medicine, Spectrum Health, Grand Rapids, MI (J.A.O.), Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids (J.A.O., J.K., T.C.); Kent County Emergency Medical Services, MI (T.C.); and Department of Epidemiology, Michigan State University, East Lansing (M.N., M.J.R.).
Stroke. 2015 Jun;46(6):1513-7. doi: 10.1161/STROKEAHA.115.008650. Epub 2015 Apr 28.
Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification.
Using EMS and hospital records, we assembled a cohort of EMS-transported suspect, confirmed, or missed ischemic stroke or transient ischemic attack cases. The sensitivity and positive predictive value (PPV) for EMS stroke recognition were calculated using the hospital discharge diagnosis as the gold standard. We used multivariable logistic regression analysis to determine the association between Cincinnati Prehospital Stroke Scale use and EMS stroke recognition.
During a 12-month period, 441 EMS-transported patients were enrolled; of which, 371 (84.1%) were EMS-suspected strokes and 70 (15.9%) were EMS-missed strokes. Overall, 264 cases (59.9%) were confirmed as either ischemic stroke (n=186) or transient ischemic attack (n=78). The sensitivity of EMS stroke recognition was 73.5% (95% confidence interval, 67.7-78.7), and PPV was 52.3% (95% confidence interval, 47.1-57.5). Sensitivity (84.7% versus 30.9%; P<0.0001) and PPV (56.2% versus 30.4%; P=0.0004) were higher among cases with Cincinnati Prehospital Stroke Scale documentation. In multivariate analysis, Cincinnati Prehospital Stroke Scale documentation was independently associated with EMS sensitivity (odds ratio, 12.0; 95% confidence interval, 5.7-25.5) and PPV (odds ratio, 2.5; 95% confidence interval, 1.3-4.7).
EMS providers recognized 3 quarters of the patients with ischemic stroke and transient ischemic attack; however, half of EMS-suspected strokes were false positives. Documentation of a Cincinnati Prehospital Stroke Scale was associated with higher EMS stroke recognition sensitivity and PPV.
院外启动院内卒中救治流程可加快治疗速度，但这依赖于急救医疗服务（EMS）对卒中的准确识别。我们旨在评估EMS对卒中的识别准确性，并确定与正确识别卒中相关的临床因素。
利用EMS和医院记录，我们收集了一组由EMS转运的疑似、确诊或漏诊的缺血性卒中或短暂性脑缺血发作病例。以医院出院诊断作为金标准，计算EMS对卒中识别的敏感性和阳性预测值（PPV）。我们使用多变量逻辑回归分析来确定辛辛那提院前卒中量表的使用与EMS对卒中识别之间的关联。
在12个月期间，共纳入441例由EMS转运的患者；其中，371例（84.1%）被EMS怀疑为卒中，70例（15.9%）被EMS漏诊为卒中。总体而言，264例（59.9%）被确诊为缺血性卒中（n = 186）或短暂性脑缺血发作（n = 78）。EMS对卒中识别的敏感性为73.5%（95%置信区间，67.7 - 78.7），PPV为52.3%（95%置信区间，47.1 - 57.5）。有辛辛那提院前卒中量表记录的病例，其敏感性（84.7%对30.9%；P < 0.0001）和PPV（56.2%对30.4%；P = 0.0004）更高。在多变量分析中，辛辛那提院前卒中量表记录与EMS的敏感性（比值比，12.0；95%置信区间，5.7 - 25.5）和PPV（比值比，2.5；95%置信区间，1.3 - 4.7）独立相关。
EMS工作人员识别出了四分之三的缺血性卒中和短暂性脑缺血发作患者；然而，EMS怀疑的卒中病例中有一半是假阳性。辛辛那提院前卒中量表的记录与更高的EMS卒中识别敏感性和PPV相关。
