Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University, Aarhus, Denmark.
Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Acta Neurol Scand. 2022 May;145(5):541-550. doi: 10.1111/ane.13580. Epub 2022 Jan 13.
The main aim of the study is to investigate the performance of a two-part stroke scale for screening and subsequent severity assessment combined with a telephone conference (teleconference).
During a 6-month period, we prospectively tested the Prehospital Stroke Score (PreSS). PreSS part 1 is designed to identify stroke or TIA in a prehospital setting. PreSS part 2 is a stroke severity scale designed to identify large-vessel occlusion (LVO). PreSS was performed by emergency medical service (EMS) providers prior to a teleconference with a stroke neurologist.
Combined teleconference and PreSS part 1 were performed on 79.3% of all patients diagnosed with stroke/TIA, and 99.1% of the patients with positive scores were subsequently PreSS part 2 scored. PreSS part 1 and teleconference had a sensitivity to identify stroke/TIA of 89.3% (95% CI 85.7-92.2), specificity of 64.5% (95% CI 59.3-69.5), and an area under the curve (AUC) of 0.80 (95% CI 0.77-0.83). Regarding LVO, PreSS part 1 with teleconference recognized 96.7% (95% CI 88.7-99.6) of all cases as stroke. PreSS part 2 had a sensitivity of 55.7% (95% CI 42.4-68.5), specificity of 91.5% (95% CI 89.0-93.6), and AUC of 0.86 (95% CI 0.82-0.90) for identification of LVO.
PreSS was feasible and the sensitivity for stroke/TIA and LVO was high to moderate providing an overall high precision. Almost all LVO cases were ensured acute stroke admission. The high specificity for LVO could be useful for determining transfers strategies.
This study provides Class I evidence when evaluating PreSS combined with teleconference.
本研究的主要目的是调查一种由两部分组成的卒中量表在与电话会议（远程会议）相结合的情况下进行筛查和后续严重程度评估的性能。
在 6 个月的时间内，我们前瞻性地测试了院前卒中评分（PreSS）。PreSS 第 1 部分旨在识别院前环境中的卒中或 TIA。PreSS 第 2 部分是一种卒中严重程度量表，用于识别大血管闭塞（LVO）。PreSS 由紧急医疗服务（EMS）提供者在与卒中神经科医生进行远程会议之前进行。
在所有诊断为卒中/TIA 的患者中，有 79.3%进行了联合远程会议和 PreSS 第 1 部分检查，而阳性评分的患者中有 99.1%随后进行了 PreSS 第 2 部分评分。PreSS 第 1 部分和远程会议识别卒中/TIA 的敏感性为 89.3%（95%CI 85.7-92.2），特异性为 64.5%（95%CI 59.3-69.5），曲线下面积（AUC）为 0.80（95%CI 0.77-0.83）。关于 LVO，PreSS 第 1 部分结合远程会议识别了所有病例中的 96.7%（95%CI 88.7-99.6）为卒中。PreSS 第 2 部分的敏感性为 55.7%（95%CI 42.4-68.5），特异性为 91.5%（95%CI 89.0-93.6），AUC 为 0.86（95%CI 0.82-0.90）用于识别 LVO。
PreSS 是可行的，卒中/TIA 和 LVO 的敏感性为高到中度，提供了总体高精度。几乎所有的 LVO 病例都确保了急性卒中入院。LVO 的高特异性可用于确定转移策略。
本研究在评估结合远程会议的 PreSS 时提供了 I 级证据。
