Wagstaff Holden M, Crowe Remle P, Youngquist Scott T, Stoecklein H Hill, Treichel Ali, He Yao, Majersik Jennifer J
medRxiv. 2024 May 4:2024.05.02.24306794. doi: 10.1101/2024.05.02.24306794.
Previous research demonstrated that the numerical Cincinnati Prehospital Stroke Scale (CPSS) identifies large vessel occlusion (LVO) at similar rates compared to a limited number of stroke severity screening tools. We aimed to compare numerical CPSS to additional stroke scales using a national EMS database.
Using the ESO Data Collaborative, the largest EMS database with hospital linked data, we retrospectively analyzed prehospital patient records for the year 2022. Stroke and LVO diagnoses were determined by ICD-10 codes from linked hospital discharge and emergency department records. Prehospital CPSS was compared to the Cincinnati Stroke Triage Assessment Tool (C-STAT), the Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and the Balance Eyes Face Arm Speech Time (BE-FAST). The optimal prediction cut-points for LVO screening were determined by intersecting the sensitivity and specificity curves for each scale. To compare the discriminative abilities of each scale among those diagnosed with LVO, we used the area under the receiver operating curve (AUROC).
We identified 17,442 prehospital records from 754 EMS agencies with ≥ 1 documented stroke scale of interest: 30.3% (n=5,278) had a hospital diagnosis of stroke, of which 71.6% (n=3,781) were ischemic; of those, 21.6% (n=817) were diagnosed with LVO. CPSS score ≥ 2 was found to be predictive of LVO with 76.9% sensitivity, 68.0% specificity, and AUROC 0.787 (95% CI 0.722-0.801). All other tools had similar predictive abilities, with sensitivity / specificity / AUROC of: C-STAT 62.5% / 76.5% / 0.727 (0.555-0.899); FAST-ED 61.4% / 76.1%/ 0.780 (0.725-0.836); BE-FAST 70.4% / 67.1% / 0.739 (0.697-0.788).
The less complex CPSS exhibited comparable performance to three frequently employed LVO detection tools. EMS agency leadership, medical directors, stroke system directors, and other stroke leaders may consider the complexity of stroke severity instruments and challenges with ensuring accurate recall and consistent application when selecting which instrument to implement. Use of the simpler CPSS may enhance compliance with the utilization of LVO screening instruments while maintaining the accuracy of prehospital LVO determination.
先前的研究表明，数字式辛辛那提院前卒中量表（CPSS）与数量有限的卒中严重程度筛查工具相比，识别大血管闭塞（LVO）的比例相似。我们旨在使用全国紧急医疗服务（EMS）数据库，将数字式CPSS与其他卒中量表进行比较。
利用ESO数据协作组织（拥有与医院链接数据的最大EMS数据库），我们回顾性分析了2022年的院前患者记录。卒中及LVO诊断通过来自链接的医院出院和急诊科记录的ICD-10编码确定。将院前CPSS与辛辛那提卒中分诊评估工具（C-STAT）、急诊目的地现场评估卒中分诊（FAST-ED）以及平衡眼脸面部手臂言语时间（BE-FAST）进行比较。通过交叉每个量表的敏感性和特异性曲线，确定LVO筛查的最佳预测切点。为了比较各量表在LVO诊断患者中的鉴别能力，我们使用了受试者操作特征曲线下面积（AUROC）。
我们从754个EMS机构中识别出17442份院前记录，这些机构至少有1份记录了感兴趣的卒中量表：30.3%（n = 5278）的患者被医院诊断为卒中，其中71.6%（n = 3781）为缺血性卒中；在这些缺血性卒中患者中，21.6%（n = 817）被诊断为LVO。发现CPSS评分≥2可预测LVO，敏感性为76.9%，特异性为68.0%，AUROC为0.787（95%CI 0.722 - 0.801）。所有其他工具具有相似的预测能力，其敏感性/特异性/AUROC分别为：C-STAT 62.5% / 76.5% / 0.727（0.555 - 0.899）；FAST-ED 61.4% / 76.1% / 0.780（0.725 - 0.836）；BE-FAST 70.4% / 67.1% / 0.739（0.697 - 0.788）。
较简单的CPSS与三种常用的LVO检测工具表现相当。EMS机构领导、医疗主任、卒中系统主任和其他卒中领域负责人在选择实施哪种工具时，可能会考虑卒中严重程度评估工具的复杂性以及确保准确回忆和一致应用所面临的挑战。使用更简单的CPSS可能会提高对LVO筛查工具的依从性，同时保持院前LVO判定的准确性。
