Yuksen Chaiyaporn, Tienpratarn Welawat, Treerasoradaj Thitibud, Jenpanitpong Chetsadakon, Termkijwanich Phatcha
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Open Access Emerg Med. 2023 Feb 9;15:53-60. doi: 10.2147/OAEM.S398061. eCollection 2023.
Large vessel occlusive (LVO) stroke causes severe disabilities and occurs in more than 37% of strokes. Reperfusion therapy is the gold standard of treatment. Studies proved that endovascular thrombectomy (EVT) is more beneficial and decreases mortality. This study aimed to evaluate the factor associated with LVO stroke in an Asian population and to develop the scores to predict LVO in a prehospital setting. The score will hugely contribute to the future of stroke care in prehospital settings in the aspect of transferal suspected LVO stroke patients to appropriate EVT-capable stroke centers.
This study was a retrospective cohort study using an exploratory model at the emergency department of Ramathibodi Hospital, Bangkok, Thailand, between January 2018 and December 2020. We included the stroke patients aged >18 who visit ED and an available radiologic report representing LVO. Those whose stroke onset was >24 hours and no radiologic report were excluded. Multivariable logistic regression analysis developed the prediction model and score for LVO stroke.
A total of 252 patients met the inclusion criteria; 61 cases (24%) had LVO stroke. Six independent factors were significantly predictive: comorbidity with atrial fibrillation, clinical hemineglect, gaze deviation, facial palsy, aphasia, and cerebellar sign abnormality. The predicted score had an accuracy of 92.5%. The LVO risk score was categorized into three groups: low risk (LVO score <3), moderate risk (LVO score 3-6), and high risk (LVO score >6). The positive likelihood ratio to predicting LVO stroke were 0.12 (95% CI 0.06-0.26), 2.33 (95% CI 1.53-3.53) and 45.40 (95% CI 11.16-184.78), respectively.
The Large Vessel Occlusion (LVO) Risk Score provides a screening tool for predicting LVO stroke. A clinical predictive score of ≥3 appears to be associated with LVO stroke.
大血管闭塞性（LVO）卒中会导致严重残疾，在超过37%的卒中病例中出现。再灌注治疗是治疗的金标准。研究证明，血管内血栓切除术（EVT）更有益且可降低死亡率。本研究旨在评估亚洲人群中与LVO卒中相关的因素，并制定在院前环境中预测LVO的评分。该评分将在将疑似LVO卒中患者转运至具备适当EVT能力的卒中中心方面，对院前卒中护理的未来发展做出巨大贡献。
本研究是一项回顾性队列研究，于2018年1月至2020年12月在泰国曼谷拉玛提波迪医院急诊科采用探索性模型。我们纳入了年龄大于18岁且前往急诊科就诊并有代表LVO的可用放射学报告的卒中患者。排除卒中发作超过24小时且无放射学报告的患者。多变量逻辑回归分析建立了LVO卒中的预测模型和评分。
共有252例患者符合纳入标准；61例（24%）患有LVO卒中。六个独立因素具有显著预测性：合并房颤、临床偏侧忽视、凝视偏斜、面瘫、失语和小脑体征异常。预测评分的准确率为92.5%。LVO风险评分分为三组：低风险（LVO评分<3）、中度风险（LVO评分3 - 6）和高风险（LVO评分>6）。预测LVO卒中的阳性似然比分别为0.12（95%CI 0.06 - 0.26）、2.33（95%CI 1.53 - 3.53）和45.40（95%CI 11.16 - 184.78）。
大血管闭塞（LVO）风险评分提供了一种预测LVO卒中的筛查工具。临床预测评分≥3似乎与LVO卒中相关。
