Department of Neurology, St. John's Hospital, Vienna, Austria.
Medical Faculty, Sigmund Freud University, Vienna, Austria.
Acta Neurol Scand. 2022 Sep;146(3):246-251. doi: 10.1111/ane.13654. Epub 2022 May 20.
The Austrian Prehospital Stroke Scale (APSS) score was developed to predict large vessel occlusion (LVO) and improve prehospital transportation triage. Its accuracy has been previously analyzed retrospectively. We now aimed to investigate the accuracy, as well as the impact of the implementation of a triage strategy using this score on treatment times and outcome in a prospective study.
MATHERIAL & METHODS: Prospective diagnostic test accuracy and before-after interventional study. EMS prospectively evaluated APSS in patients suspected of stroke. Accuracy was compared with other LVO scores. Patients with APSS ≥4 points were brought directly to the comprehensive stroke center. Treatment time frames, neurological, and radiological outcome before and after the APSS implementation were compared.
A total of 307 patients with suspected stroke were included from October 2018 to February 2020. Treatable LVO was present in 79 (26%). Sensitivity of APSS to detect those was 90%, specificity 79%, positive predictive value 66%, negative predictive value 95%, and area under the curve 0.87 (95% CI 0.83-0.91). This was similar to in-hospital NIHSS (AUC 0.89 95% CI 0.89-0.92, p = .06) and superior to CPSS (AUC 0.83 95% CI 0.78-0.87, p = .01). Implementation of APSS triage increased direct transportation rate for LVO patients (21% before vs. 52% after; p < .001) with a significant time benefit (alert to groin puncture time benefit: 51 min (95% CI 28-74; p < .001). Neurological and radiological outcome did not differ significantly.
Austrian Prehospital Stroke Scale triage showed an accuracy comparable with in-hospital NIHSS, and lead to a significant optimization of prehospital workflows in patients with potential LVO.
奥地利院前卒中量表（APSS）的开发目的是预测大血管闭塞（LVO）并改善院前转运分诊。其准确性此前已进行回顾性分析。我们现在旨在研究在一项前瞻性研究中，该评分的准确性以及实施分诊策略对治疗时间和结果的影响。
前瞻性诊断测试准确性和干预前后的研究。EMS 前瞻性评估疑似卒中患者的 APSS。将准确性与其他 LVO 评分进行比较。APSS≥4 分的患者直接送往综合卒中中心。比较实施 APSS 前后的治疗时间框架、神经学和影像学结果。
2018 年 10 月至 2020 年 2 月，共纳入 307 例疑似卒中患者。有可治疗性 LVO 的患者有 79 例（26%）。APSS 检测这些患者的敏感性为 90%，特异性为 79%，阳性预测值为 66%，阴性预测值为 95%，曲线下面积为 0.87（95%CI 0.83-0.91）。这与院内 NIHSS 相似（AUC 0.89 95%CI 0.89-0.92，p=0.06），优于 CPSS（AUC 0.83 95%CI 0.78-0.87，p=0.01）。APSS 分诊的实施增加了 LVO 患者的直接转运率（21% vs. 52%；p<0.001），并具有显著的时间优势（从警报到腹股沟穿刺的时间优势：51 分钟（95%CI 28-74；p<0.001）。神经学和影像学结果无显著差异。
奥地利院前卒中量表的分诊与院内 NIHSS 相当，可显著优化潜在 LVO 患者的院前工作流程。
