洛杉矶运动量表作为护理人员评估中风严重程度工具的现场验证
Field Validation of the Los Angeles Motor Scale as a Tool for Paramedic Assessment of Stroke Severity.
作者信息
Kim Joon-Tae, Chung Pil-Wook, Starkman Sidney, Sanossian Nerses, Stratton Samuel J, Eckstein Marc, Pratt Frank D, Conwit Robin, Liebeskind David S, Sharma Latisha, Restrepo Lucas, Tenser May-Kim, Valdes-Sueiras Miguel, Gornbein Jeffrey, Hamilton Scott, Saver Jeffrey L
机构信息
From the Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K.); Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea (P.-W.C.); Department of Emergency Medicine and Neurology (S.S.), Department of Emergency (F.D.P.), Department of Neurology and Comprehensive Stroke Center (D.S.L., L.S., L.R., M.V.-S., J.L.S.), Neurovascular Imaging Research Core (D.S.L.), and Department of Biomathematics (J.G.), David Geffen School of Medicine, University of California, Los Angeles; Department of Neurology, University of Southern California, Los Angeles (N.S., M.-K.T.); Department of Emergency Medicine, Los Angeles EMS Agency, Orange County EMS Agency, Harbor-University of California, Los Angeles Medical Center (S.J.S.); Department of Emergency Medicine, Keck School of Medicine of the University of Southern California and Los Angeles Fire Department (M.E.); Los Angeles County Department of Public Health, CA (F.D.P.); National Institutes of Health, National Institutes of Neurological Disorders and Stroke, Bethesda, MD (R.C.); and School of Medicine, Stanford University, Palo Alto, CA (S.H.).
出版信息
Stroke. 2017 Feb;48(2):298-306. doi: 10.1161/STROKEAHA.116.015247. Epub 2017 Jan 13.
BACKGROUND AND PURPOSE
The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region.
METHODS
We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals.
RESULTS
Among 1632 acute cerebrovascular disease patients (age 70±13 years, male 57.5%), time from onset to prehospital LAMS was median 30 minutes (interquartile range 20-50), onset to early postarrival (EPA) LAMS was 145 minutes (interquartile range 119-180), and onset to EPA National Institutes of Health Stroke Scale was 150 minutes (interquartile range 120-180). Between the prehospital and EPA assessments, LAMS scores were stable in 40.5%, improved in 37.6%, and worsened in 21.9%. In tests of convergent validity, against the EPA National Institutes of Health Stroke Scale, correlations were r=0.49 for the prehospital LAMS and r=0.89 for the EPA LAMS. Prehospital LAMS scores did diverge from the prehospital Glasgow Coma Scale, r=-0.22. Predictive accuracy (adjusted C statistics) for nondisabled 3-month outcome was as follows: prehospital LAMS, 0.76 (95% confidence interval 0.74-0.78); EPA LAMS, 0.85 (95% confidence interval 0.83-0.87); and EPA National Institutes of Health Stroke Scale, 0.87 (95% confidence interval 0.85-0.88).
CONCLUSIONS
In this multicenter, prospective, prehospital study, the LAMS showed good to excellent convergent, divergent, and predictive validity, further establishing it as a validated instrument to characterize stroke severity in the field.
背景与目的
洛杉矶运动量表（LAMS）是一种为院前使用而开发的包含3个项目、评分范围为0至10分的运动性卒中缺陷量表。我们在一个地域广阔且多样的多个地点，评估了护理人员在现场使用LAMS时的收敛效度、区分效度和预测效度。
方法
我们前瞻性分析了在急性卒中治疗镁剂3期（FAST-MAG）试验中收集的早期评估和结局数据，该试验纳入了发病2小时内的急性脑血管疾病（脑缺血和颅内出血）患者，由315辆救护车转运至60家接收医院。
结果
在1632例急性脑血管疾病患者中（年龄70±13岁，男性占57.5%），从发病到院前LAMS评估的时间中位数为30分钟（四分位间距20 - 50），发病到到达后早期（EPA）LAMS评估的时间为145分钟（四分位间距为119 - 180），发病到EPA美国国立卫生研究院卒中量表评估的时间为150分钟（四分位间距为120 - 180）。在院前和EPA评估之间，LAMS评分稳定的占40.5%，改善的占37.6%，恶化的占21.9%。在收敛效度测试中，与EPA美国国立卫生研究院卒中量表相比，院前LAMS的相关性r = 0.49，EPA LAMS的相关性r = 0.89。院前LAMS评分与院前格拉斯哥昏迷量表确实存在差异，r = -0.22。非残疾3个月结局的预测准确性（校正C统计量）如下：院前LAMS为0.76（95%置信区间0.74 - 0.78）；EPA LAMS为0.85（95%置信区间0.83 - 0.87）；EPA美国国立卫生研究院卒中量表为0.87（95%置信区间0.85 - 0.88）。
结论
在这项多中心、前瞻性的院前研究中，LAMS显示出良好至优异的收敛效度、区分效度和预测效度，进一步确立了它作为一种在现场评估卒中严重程度的有效工具。
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