Dekker Luuk, Moudrous Walid, Daems Jasper D, Buist Ewout Fh, Venema Esmee, Durieux Marcel Dj, van Zwet Erik W, de Schryver Els Llm, Kloos Loet Mh, de Laat Karlijn F, Aerden Leo Am, Dippel Diederik Wj, Kerkhoff Henk, van den Wijngaard Ido R, Wermer Marieke Jh, Roozenbeek Bob, Kruyt Nyika D
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands.
Int J Stroke. 2025 Mar;20(3):268-277. doi: 10.1177/17474930241275123. Epub 2024 Sep 10.
Several prehospital scales have been designed to aid paramedics in identifying stroke patients in the ambulance setting. However, external validation and comparison of these scales are largely lacking.
To compare all published prehospital stroke detection scales in a large cohort of unselected stroke code patients.
We conducted a systematic literature search to identify all stroke detection scales. Scales were reconstructed with prehospital acquired data from two observational cohort studies: the Leiden Prehospital Stroke Study (LPSS) and PREhospital triage of patients with suspected STrOke (PRESTO) study. These included stroke code patients from four ambulance regions in the Netherlands, including 15 hospitals and serving 4 million people. For each scale, we calculated the accuracy, sensitivity, and specificity for a diagnosis of stroke (ischemic, hemorrhagic, or transient ischemic attack (TIA)). Moreover, we assessed the proportion of stroke patients who received reperfusion treatment with intravenous thrombolysis or endovascular thrombectomy that would have been missed by each scale.
We identified 14 scales, of which 7 (CPSS, FAST, LAPSS, MASS, MedPACS, OPSS, and sNIHSS-EMS) could be reconstructed. Of 3317 included stroke code patients, 2240 (67.5%) had a stroke (1528 ischemic, 242 hemorrhagic, 470 TIA) and 1077 (32.5%) a stroke mimic. Of ischemic stroke patients, 715 (46.8%) received reperfusion treatment. Accuracies ranged from 0.60 (LAPSS) to 0.66 (MedPACS, OPSS, and sNIHSS-EMS), sensitivities from 66% (LAPSS) to 84% (MedPACS and sNIHSS-EMS), and specificities from 28% (sNIHSS-EMS) to 49% (LAPSS). MedPACS, OPSS, and sNIHSS-EMS missed the fewest reperfusion-treated patients (10.3-11.2%), whereas LAPSS missed the most (25.5%).
Prehospital stroke detection scales generally exhibited high sensitivity but low specificity. While LAPSS performed the poorest, MedPACS, sNIHSS-EMS, and OPSS demonstrated the highest accuracy and missed the fewest reperfusion-treated stroke patients. Use of the most accurate scale could reduce unnecessary stroke code activations for patients with a stroke mimic by almost a third, but at the cost of missing 16% of strokes and 10% of patients who received reperfusion treatment.
已经设计了几种院前量表，以帮助护理人员在救护车上识别中风患者。然而，这些量表在很大程度上缺乏外部验证和比较。
在一大群未经选择的中风急救患者中比较所有已发表的院前中风检测量表。
我们进行了系统的文献检索，以识别所有中风检测量表。使用来自两项观察性队列研究（莱顿院前中风研究（LPSS）和疑似中风患者的院前分诊（PRESTO）研究）的院前获取数据重建量表。这些研究包括来自荷兰四个救护区的中风急救患者，包括15家医院，服务400万人。对于每个量表，我们计算了诊断中风（缺血性、出血性或短暂性脑缺血发作（TIA））的准确性、敏感性和特异性。此外，我们评估了每个量表会遗漏的接受静脉溶栓或血管内血栓切除术再灌注治疗的中风患者比例。
我们识别出14个量表，其中7个（CPSS、FAST、LAPSS、MASS、MedPACS、OPSS和sNIHSS-EMS）可以重建。在3317名纳入的中风急救患者中，2240名（67.5%）患有中风（1528例缺血性中风、242例出血性中风、470例TIA），1077名（32.5%）为疑似中风。在缺血性中风患者中，715名（46.8%）接受了再灌注治疗。准确性范围为0.60（LAPSS）至0.66（MedPACS、OPSS和sNIHSS-EMS），敏感性范围为66%（LAPSS）至84%（MedPACS和sNIHSS-EMS），特异性范围为28%（sNIHSS-EMS）至49%（LAPSS）。MedPACS、OPSS和sNIHSS-EMS遗漏的接受再灌注治疗的患者最少（10.3 - 11.2%），而LAPSS遗漏的最多（25.5%）。
院前中风检测量表通常表现出高敏感性但低特异性。虽然LAPSS表现最差，但MedPACS、sNIHSS-EMS和OPSS显示出最高的准确性，并且遗漏的接受再灌注治疗的中风患者最少。使用最准确的量表可以将疑似中风患者不必要的中风急救激活减少近三分之一，但代价是遗漏16%的中风患者和10%接受再灌注治疗的患者。
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