Department of Neurology & Stroke Unit, Sant'Anna Hospital, Como, Italy.
Department of Neurology & Stroke Unit, Niguarda Ca' Granda Hospital, Milan, Italy.
Acta Neurol Scand. 2018 Jul;138(1):24-31. doi: 10.1111/ane.12908. Epub 2018 Feb 11.
Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate selection and identification of patients with high probability of a large vessel occlusion (LVO) in the prehospital setting improve the rationalization of the transport in the more suitable centers. Aim of this analysis was to determine the diagnostic accuracy of prehospital stroke scales detecting LVO.
Studies were searched into MEDLINE, EMBASE, and CINHAL databases between January 1990 and September 2017. Principal measurements of the meta-analysis were the overall accuracy level, sensitivity, and specificity of prehospital stroke scales.
Nineteen scoring systems were included in the analysis coming from 13 studies. A total of 9824 patients were considered. Although a higher heterogeneity was observed in the analysis, three scores showed better results in predicting a LVO (the stroke Vision, Aphasia, Neglect assessment, the National Institute of Health Stroke scale and the Los Angeles Motor Scale). We observed significant differences of overall accuracy only for scores including hemineglect as cortical neurological sign (P < .05).
This meta-analysis suggests that some prehospital scoring systems including cortical signs showed better accuracy to predict stroke due to LVO. However, the assessment of these signs could be difficult to investigate by paramedics and personnel of Emergency Medical Services, and for this reason, further prospective evaluations are needed.
急性缺血性脑卒中的药物和机械动脉再通的时间敏感性会影响参考医院的选择。在院前环境中准确选择和识别具有大血管闭塞（LVO）高概率的患者，可以提高在更合适的中心进行合理化转运的能力。本分析的目的是确定院前卒中量表检测 LVO 的诊断准确性。
检索了 1990 年 1 月至 2017 年 9 月 MEDLINE、EMBASE 和 CINHAL 数据库中的研究。荟萃分析的主要测量指标是院前卒中量表的整体准确性水平、敏感度和特异性。
分析中纳入了 13 项研究的 19 种评分系统，共纳入了 9824 例患者。尽管分析中观察到较高的异质性，但有 3 种评分在预测 LVO 方面表现出更好的结果（卒中视觉、失语症、忽略评估、国立卫生研究院卒中量表和洛杉矶运动量表）。我们仅观察到包括偏侧忽略作为皮质神经体征的评分在总体准确性方面存在显著差异（P<.05）。
本荟萃分析表明，一些包括皮质体征的院前评分系统在预测 LVO 引起的脑卒中方面具有更高的准确性。然而，这些体征的评估可能难以由护理人员和急诊医疗服务人员进行调查，因此需要进一步进行前瞻性评估。
