Karimi Somayeh, Dutra E Oliva Lorraine Martins, Rafiemanesh Hosein, Mendez Capitaine Melissa, Jabre Sarah, Baratloo Alireza
Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Nove de Julho University (UNINOVE), Sao Paulo, Brazil.
Arch Acad Emerg Med. 2023 Feb 20;11(1):e23. doi: 10.22037/aaem.v11i1.1941. eCollection 2023.
Just as failure to diagnose an acute ischemic stroke (AIS) in a timely manner affects the patient's outcome; an inaccurate and misplaced impression of the AIS diagnosis is not without its drawbacks. Here, we introduce a two-stage clinical tool to aid in the screening of AIS cases in need of imaging in the emergency department (ED).
This was a multicenter cross-sectional study, in which suspected AIS patients who underwent a brain magnetic resonance imaging (MRI) were included. The 18 variables from nine existing AIS screening tools were extracted and a two-stage screening tool was developed based on expert opinion (stage-one or rule in stage) and multivariate logistic regression analysis (stage-two or rule out stage). Then, the screening performance characteristics of the two-stage mode was evaluated.
Data from 803 patients with suspected AIS were analyzed. Among them, 57.4 % were male, and their overall mean age was 66.9 ± 13.9 years. There were 561 (69.9%) cases with a final confirmed diagnosis of AIS. The total sensitivity and specificity of the two-stage screening model were 99.11% (95% CI: 98.33 to 99.89) and 35.95% (95% CI: 29.90 to 42.0), respectively. Also, the positive and negative predictive values of two-stage screening model were 78.20% (95% CI: 75.17 to 81.24) and 94.57% (95% CI: 89.93 to 81.24), respectively. The area under the receiver operating characteristic (ROC) curve of the two-stage screening model for AIS was 67.53% (95% CI: 64.48 to 70.58). Overall, using the two-stage screening model presented in this study, more than 11% of suspected AIS patients were not referred for MRI, and the error of this model is about 5%.
Here, we proposed a 2-step model for approaching suspected AIS patients in ED for an attempt to safely exclude patients with the least probability of having an AIS as a diagnosis. However, further surveys are required to assess its accuracy and it may even need some modifications.
正如未能及时诊断急性缺血性卒中（AIS）会影响患者的预后一样，对AIS诊断的不准确和错误判断也并非没有弊端。在此，我们介绍一种两阶段临床工具，以协助在急诊科（ED）筛查需要进行影像学检查的AIS病例。
这是一项多中心横断面研究，纳入了接受脑部磁共振成像（MRI）检查的疑似AIS患者。提取了来自九种现有AIS筛查工具的18个变量，并基于专家意见（第一阶段或纳入阶段）和多变量逻辑回归分析（第二阶段或排除阶段）开发了一种两阶段筛查工具。然后，评估了两阶段模式的筛查性能特征。
分析了803例疑似AIS患者的数据。其中，57.4%为男性，总体平均年龄为66.9±13.9岁。最终确诊为AIS的病例有561例（69.9%）。两阶段筛查模型的总敏感性和特异性分别为99.11%（95%CI：98.33至99.89）和35.95%（95%CI：29.90至42.0）。此外，两阶段筛查模型的阳性和阴性预测值分别为78.20%（95%CI：75.17至81.24）和94.57%（95%CI：89.93至99.11）。AIS两阶段筛查模型的受试者操作特征（ROC）曲线下面积为67.53%（95%CI：64.48至70.58）。总体而言，使用本研究中提出的两阶段筛查模型，超过11%的疑似AIS患者未被转诊进行MRI检查，该模型的误差约为5%。
在此，我们提出了一种针对急诊科疑似AIS患者的两步模型，试图安全地排除诊断为AIS可能性最小的患者。然而，需要进一步的调查来评估其准确性，甚至可能需要进行一些修改。
