Prehosp Emerg Care. 2021 Jul-Aug;25(4):465-474. doi: 10.1080/10903127.2020.1800877. Epub 2020 Aug 7.
Prehospital prediction models to estimate the likelihood of several types of stroke (large vessel occlusion [LVO], intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH], and other types of stroke) should be useful to transfer those with suspected stroke to appropriate facilities. We recently reported Japan Urgent Stroke Triage (JUST) score with 21 items had excellent predictive abilities, and we further tried to simplify the score with parsimonious items and comparable predictive abilities.
We conducted historical and prospective multicenter cohort studies at 8 centers from June 2015 to March 2018. We developed the prediction rules with select variables from JUST score for LVO, ICH, SAH and other types of stroke in 2236 patients with suspected stroke in historical derivation cohort. We validated the developed prediction rules in 964 patients in prospective validation cohort.
There were 1150 stroke, including 235 LVO, 352 ICH, 107 SAH and 456 other types of stroke in the derivation cohort. We developed the scores with 7 items (high blood pressure, arrhythmia, conjugate deviation, headache, dysarthria, disturbance of consciousness, paralysis of upper limbs) and the developed scores had area under the receiver-operating curve (AUC) of 0.84 for any type of stroke, 0.89 for LVO, 0.79 for ICH, and 0.90 for SAH in the derivation cohort. There were 490 stroke, including 102 LVO, 138 ICH, 28 SAH and 222 other types of stroke in the validation cohort. The scores well discriminated these strokes in the validation cohort (AUC of 0.76 for any type of stroke; 0.81 for LVO, 0.73 for ICH, and 0.85 for SAH).
The simplified 7-item JUST (JUST-7) score had good predictive ability and can help healthcare providers to estimate the likelihood of different types of stroke and decide the referral hospital.
用于预测多种类型卒中（大血管闭塞[LVO]、颅内出血[ICH]、蛛网膜下腔出血[SAH]和其他类型卒中）可能性的院前预测模型，对于将疑似卒中患者转送至合适的医疗机构应该是有用的。我们最近报道了日本卒中急救分诊（JUST）评分，该评分包含 21 项，具有优异的预测能力，我们进一步尝试通过简化评分并保留关键项目，来维持相当的预测能力。
我们于 2015 年 6 月至 2018 年 3 月在 8 个中心开展了历史回顾性和前瞻性多中心队列研究。我们从 JUST 评分中选择变量，在 2236 例疑似卒中的历史推导队列中建立了 LVO、ICH、SAH 和其他类型卒中的预测规则。我们在前瞻性验证队列的 964 例患者中验证了所建立的预测规则。
推导队列中共有 1150 例卒中，包括 235 例 LVO、352 例 ICH、107 例 SAH 和 456 例其他类型卒中。我们建立了包含 7 个项目（高血压、心律失常、同向偏盲、头痛、构音障碍、意识障碍、上肢瘫痪）的评分，该评分在推导队列中的任何类型卒中、LVO、ICH 和 SAH 的受试者工作特征曲线（ROC）下面积（AUC）分别为 0.84、0.89、0.79 和 0.90。验证队列中共有 490 例卒中，包括 102 例 LVO、138 例 ICH、28 例 SAH 和 222 例其他类型卒中。该评分在验证队列中能够很好地区分这些卒中（任何类型卒中的 AUC 为 0.76；LVO 的 AUC 为 0.81；ICH 的 AUC 为 0.73；SAH 的 AUC 为 0.85）。
简化的 7 项 JUST（JUST-7）评分具有良好的预测能力，有助于医疗保健提供者评估不同类型卒中的可能性，并决定转诊医院。
