Stroke. 2018 Mar;49(3):e111-e122. doi: 10.1161/STR.0000000000000160. Epub 2018 Jan 24.
Endovascular thrombectomy is a highly efficacious treatment for large vessel occlusion (LVO). LVO prediction instruments, based on stroke signs and symptoms, have been proposed to identify stroke patients with LVO for rapid transport to endovascular thrombectomy-capable hospitals. This evidence review committee was commissioned by the American Heart Association/American Stroke Association to systematically review evidence for the accuracy of LVO prediction instruments.
Medline, Embase, and Cochrane databases were searched on October 27, 2016. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy-2 tool.
Thirty-six relevant studies were identified. Most studies (21 of 36) recruited patients with ischemic stroke, with few studies in the prehospital setting (4 of 36) and in populations that included hemorrhagic stroke or stroke mimics (12 of 36). The most frequently studied prediction instrument was the National Institutes of Health Stroke Scale. Most studies had either some risk of bias or unclear risk of bias. Reported discrimination of LVO mostly ranged from 0.70 to 0.85, as measured by the C statistic. In meta-analysis, sensitivity was as high as 87% and specificity was as high as 90%, but no threshold on any instruments predicted LVO with both high sensitivity and specificity. With a positive LVO prediction test, the probability of LVO could be 50% to 60% (depending on the LVO prevalence in the population), but the probability of LVO with a negative test could still be ≥10%.
No scale predicted LVO with both high sensitivity and high specificity. Systems that use LVO prediction instruments for triage will miss some patients with LVO and milder stroke. More prospective studies are needed to assess the accuracy of LVO prediction instruments in the prehospital setting in all patients with suspected stroke, including patients with hemorrhagic stroke and stroke mimics.
血管内血栓切除术是治疗大血管闭塞（LVO）的一种非常有效的治疗方法。已经提出了基于中风症状和体征的血管内血栓切除术预测工具，以识别具有 LVO 的中风患者，以便快速转运至有血管内血栓切除术能力的医院。本证据审查委员会受美国心脏协会/美国中风协会委托，系统地审查了 LVO 预测工具的准确性证据。
于 2016 年 10 月 27 日在 Medline、Embase 和 Cochrane 数据库中进行检索。使用诊断准确性质量评估工具-2 评估研究质量。
确定了 36 项相关研究。大多数研究（36 项中的 21 项）招募了缺血性中风患者，很少有研究是在院前环境中进行的（36 项中的 4 项），也没有包括出血性中风或中风模拟患者的研究（36 项中的 12 项）。研究最多的预测工具是美国国立卫生研究院中风量表。大多数研究都存在一定的偏倚风险或不明确的偏倚风险。LVO 的报告诊断率大多在 0.70 至 0.85 之间，以 C 统计值衡量。在荟萃分析中，灵敏度高达 87%，特异性高达 90%，但没有任何仪器的阈值可以同时具有高灵敏度和特异性来预测 LVO。阳性 LVO 预测测试的情况下，LVO 的概率可能为 50%至 60%（取决于人群中的 LVO 患病率），但阴性测试的 LVO 概率仍可能≥10%。
没有任何一种量表可以同时具有高灵敏度和高特异性来预测 LVO。使用 LVO 预测工具进行分诊的系统可能会错过一些 LVO 和较轻中风的患者。需要更多的前瞻性研究来评估 LVO 预测工具在所有疑似中风患者中的准确性，包括出血性中风和中风模拟患者。
