Gropen Toby I, Boehme Amelia, Martin-Schild Sheryl, Albright Karen, Samai Alyana, Pishanidar Sammy, Janjua Nazli, Brandler Ethan S, Levine Steven R
Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology, Columbia University Medical Center, New York, NY.
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):806-815. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.018. Epub 2017 Nov 22.
This study aims to develop a simple scale to identify patients with prehospital stroke with large vessel occlusion (LVO), without losing sensitivity for other stroke types.
The Emergency Medical Stroke Assessment (EMSA) was derived from the National Institutes of Health Stroke Scale (NIHSS) items and validated for prediction of LVO in a separate cohort. We compared the EMSA with the 3-item stroke scale (3I-SS), Cincinnati Prehospital Stroke Severity Scale (C-STAT), Rapid Arterial oCclusion Evaluation (RACE) scale, and Field Assessment Stroke Triage for Emergency Destination (FAST-ED) for prediction of LVO and stroke. We surveyed paramedics to assess ease of use and interpretation of scales.
The combination of gaze preference, facial asymmetry, asymmetrical arm and leg drift, and abnormal speech or language yielded the EMSA. An EMSA less than 3, 75% sensitivity, and 50% specificity significantly reduced the likelihood of LVO (LR- = .489, 95% confidence interval .366-0.637) versus 3I-SS less than 4 (.866, .798-0.926). A normal EMSA, 93% sensitivity, and 47% specificity significantly reduced the likelihood of stroke (LR- = .142, .068-0.299) versus 3I-SS (.476, .330-0.688) and C-STAT (.858, .717-1.028). EMSA was rated easy to perform by 72% (13 of 18) of paramedics versus 67% (12 of 18) for FAST-ED and 6% (1 of 18) for RACE (χ = 27.25, P < .0001), and easy to interpret by 94% (17 of 18) versus 56% (10 of 18) for FAST-ED and 11% (2 of 18) for RACE (χ = 21.13, P < .0001).
The EMSA has superior abilities to identify LVO versus 3I-SS and stroke versus 3I-SS and C-STAT. The EMSA has similar ability to triage patients with stroke compared with the FAST-ED and RACE, but is simpler to perform and interpret.
本研究旨在开发一种简单的量表，用于识别院前大血管闭塞（LVO）性卒中患者，同时不降低对其他类型卒中的敏感性。
紧急医疗卒中评估（EMSA）源自美国国立卫生研究院卒中量表（NIHSS）项目，并在一个单独的队列中进行了验证，以预测LVO。我们将EMSA与三项卒中量表（3I-SS）、辛辛那提院前卒中严重程度量表（C-STAT）、快速动脉闭塞评估（RACE）量表以及用于紧急目的地的现场评估卒中分诊（FAST-ED）进行比较，以预测LVO和卒中。我们对护理人员进行了调查，以评估量表的易用性和可解释性。
凝视偏好、面部不对称、不对称的手臂和腿部漂移以及异常的言语或语言相结合产生了EMSA。EMSA小于3，敏感性为75%，特异性为50%，与3I-SS小于4相比（.866，.798 - 0.926），显著降低了LVO的可能性（LR- = .489，95%置信区间.366 - 0.637）。EMSA正常，敏感性为93%，特异性为47%，与3I-SS（.476，.330 - 0.688）和C-STAT（.858，.717 - 1.028）相比，显著降低了卒中的可能性（LR- = .142，.068 - 0.299）。72%（18人中有13人）的护理人员认为EMSA易于操作，而FAST-ED为67%（18人中有12人），RACE为6%（18人中有1人）（χ = 27.25，P <.0001）；94%（18人中有17人）的护理人员认为EMSA易于解释，而FAST-ED为56%（18人中有10人），RACE为11%（18人中有2人）（χ = 21.13，P <.0001）。
与3I-SS相比，EMSA在识别LVO方面具有更优的能力；与3I-SS和C-STAT相比，EMSA在识别卒中方面具有更优的能力。与FAST-ED和RACE相比，EMSA在对卒中患者进行分诊方面具有相似的能力，但操作和解释更简单。
