Duloquin Gauthier, Graber Mathilde, Garnier Lucie, Mohr Sophie, Giroud Maurice, Vergely Catherine, Béjot Yannick
Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University of Burgundy, 21078 Dijon, France.
Department of Neurology, University Hospital of Dijon, 21000 Dijon, France.
J Clin Med. 2021 Dec 15;10(24):5893. doi: 10.3390/jcm10245893.
(1) Background: The limited availability of thrombectomy-capable stroke centres raises questions about pre-hospital triage of patients with suspected stroke (IS) due to large vessel occlusion (LVO). Aims: This study aimed to evaluate the diagnostic accuracy of clinical stroke severity scales available for LVO detection. (2) Methods: Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). Clinical signs and arterial imaging data were collected. LVO was defined as an occlusion site affecting the terminal intracranial internal carotid artery, the M1 segment of the middle cerebral artery (MCA), or the basilar artery (restricted definition). A wide definition of LVO also included the M2 segment of the MCA. For each of the 16 evaluated scales, a receiver operator characteristic (ROC) analysis was performed, and the c-statistic representing the area under the ROC curve was evaluated to assess discrimination for predicting LVO. (3) Results: 971 patients were registered, including 123 patients (12.7%) with an LVO according to the restricted definition. The c-statistic for LVO detection ranged between 0.66 and 0.80 according to the different scales, with a sensibility varying from 70% to 98% and a specificity from 33% to 86%. According to the wide definition of LVO (174 patients, 17.9%), the c-statistic was slightly lower, ranging between 0.64 and 0.79. The sensitivity was 59% to 93%, and the specificity was 34% to 89%. (4) Conclusion: The clinical scales failed to combine a high sensitivity and a high specificity to detect LVO. Further studies are needed to determine the best strategy for pre-hospital triage of IS patients.
(1) 背景：具备血栓切除术能力的卒中中心数量有限，这引发了关于因大血管闭塞（LVO）导致的疑似卒中（IS）患者院前分诊的问题。目的：本研究旨在评估可用于检测LVO的临床卒中严重程度量表的诊断准确性。(2) 方法：使用基于人群的登记系统（2013 - 2017年），在法国第戎的居民中前瞻性地识别IS患者。收集临床体征和动脉成像数据。LVO被定义为影响颅内颈内动脉末端、大脑中动脉（MCA）的M1段或基底动脉的闭塞部位（狭义定义）。LVO的广义定义还包括MCA的M2段。对于16个评估量表中的每一个，进行了受试者操作特征（ROC）分析，并评估了代表ROC曲线下面积的c统计量，以评估预测LVO的辨别力。(3) 结果：登记了971例患者，其中根据狭义定义有123例患者（12.7%）发生LVO。根据不同量表，检测LVO的c统计量在0.66至0.80之间，敏感性从70%到98%不等，特异性从33%到86%不等。根据LVO的广义定义（174例患者，17.9%），c统计量略低，在0.64至0.79之间。敏感性为59%至93%，特异性为34%至89%。(4) 结论：临床量表未能同时具备检测LVO的高敏感性和高特异性。需要进一步研究以确定IS患者院前分诊的最佳策略。
