Chiu Yu-Chen, Tang Sung-Chun, Tsai Li-Kai, Hsieh Ming-Ju, Chiang Wen-Chu, Jeng Jiann-Shing, Ma Matthew Huei-Ming
Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
J Emerg Med. 2023 Feb;64(2):167-174. doi: 10.1016/j.jemermed.2022.12.027. Epub 2023 Feb 21.
A risk stratification scale is essential to identify high-risk patients who had transient ischemic attack (TIA) to prevent subsequent permanent disability caused by ischemic stroke.
This study aimed to develop and validate a scoring system to predict acute ischemic stroke within 90 days after TIA in an emergency department (ED).
We retrospectively analyzed the data of patients with TIA in a stroke registry between January 2011 and September 2018. Characteristics, medication history, electrocardiogram (ECG), and imaging findings were collected. Univariable and multivariable stepwise logistic regression analyses were performed to create an integer point system. The area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (HL) test were used to examine discrimination and calibration. Youden's Index was also used to determine the best cutoff value.
A total of 557 patients were included, and the occurrence rate of acute ischemic stroke within 90 days after TIA was 5.03%. After multivariable analysis, a new integer point system was created-MESH (Medication Electrocardiogram Stenosis Hypodense) score-which contained medication history (antiplatelet medication taken before admission, 1 point), right bundle branch block on electrocardiogram (1 point), intracranial stenosis ≥ 50% (1 point), and size of the hypodense area on computed tomography (diameter ≥ 4 cm, 2 points). The MESH score showed adequate discrimination (AUC = 0.78) and calibration (HL test = 0.78). The best cutoff value was 2 points, with a sensitivity of 60.71% and specificity of 81.66%.
The MESH score indicated improved accuracy for TIA risk stratification in the ED setting.
风险分层量表对于识别短暂性脑缺血发作（TIA）的高危患者至关重要，可预防随后因缺血性卒中导致的永久性残疾。
本研究旨在开发并验证一种评分系统，以预测急诊科（ED）中TIA后90天内发生急性缺血性卒中的风险。
我们回顾性分析了2011年1月至2018年9月卒中登记处中TIA患者的数据。收集了患者的特征、用药史、心电图（ECG）和影像学检查结果。进行单变量和多变量逐步逻辑回归分析以创建一个整数评分系统。采用受试者工作特征曲线（AUC）下面积和Hosmer-Lemeshow（HL）检验来评估区分度和校准度。还使用约登指数来确定最佳截断值。
共纳入557例患者，TIA后90天内急性缺血性卒中的发生率为5.03%。多变量分析后，创建了一个新的整数评分系统——MESH（药物、心电图、狭窄、低密度灶）评分，该评分包括用药史（入院前服用抗血小板药物，1分）、心电图右束支传导阻滞（1分）、颅内狭窄≥50%（1分）以及计算机断层扫描上低密度灶的大小（直径≥4 cm，2分）。MESH评分显示出足够的区分度（AUC = 0.78）和校准度（HL检验 = 0.78）。最佳截断值为2分，灵敏度为60.71%，特异度为81.66%。
MESH评分表明在急诊科环境中TIA风险分层的准确性有所提高。
