Hasl Marian Maximilian, Pinho João, Baldus Sophie Gina, Gerhards Anna, Wiesmann Martin, Schulz Jörg B, Reich Arno, Nikoubashman Omid
Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Aachen, Germany.
Department of Neurology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Clin Neuroradiol. 2025 Mar;35(1):17-23. doi: 10.1007/s00062-024-01449-5. Epub 2024 Aug 12.
The modified Rankin scale (mRS) is frequently used in the emergency setting to estimate pre-stroke functional status in stroke patients who are candidates to acute revascularization therapies (ps-mRS). We aimed to describe the agreement between pre-stroke mRS evaluated in the emergency department (ED-ps-mRS) and pre-stroke mRS evaluated comprehensively post-admission (PA-ps-mRS).
Retrospective study of consecutive ischemic stroke patients undergoing mechanical thrombectomy, with available ED-ps-mRS and PA-ps-mRS. ED-ps-mRS was evaluated by the treating neurologist and documented in the emergency stroke treatment protocol. PA-ps-mRS was retrospectively evaluated with information registered in the clinical record. Collection of baseline characteristics and 3‑month outcomes. Patients with ED-overestimated pre-stroke functional status (ED ps-mRS ≤ 2 and PA-ps-mRS ≥ 3) were compared to correct low and high ED-ps-mRS groups.
We included 409 patients (median age 77 years, 50% female, median NIHSS 14). Concordance of dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) was found in 81.4% (Cohen's kappa = 0.476, p < 0.001). ED-overestimated pre-stroke functional status was found in 69 patients (17%). Patients with ED-overestimated pre-stroke functional status were older (p < 0.001), more frequently presented diabetes (p < 0.001), previous stroke (p = 0.014) and less frequently presented 3‑month functional independence (p < 0.001) compared to patients with correct low ED-ps-mRS. No differences in pre-stroke baseline characteristics between overestimated and correct high ED-ps-mRS was found.
Disagreement between dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) occurred in 1/5 of patients. Overestimation of pre-stroke functional status may falsely reduce the expected proportion of patients achieving favourable 3‑month functional outcomes.
改良Rankin量表（mRS）常用于急诊环境，以评估急性血运重建治疗候选卒中患者的卒中前功能状态（ps-mRS）。我们旨在描述急诊科评估的卒中前mRS（ED-ps-mRS）与入院后综合评估的卒中前mRS（PA-ps-mRS）之间的一致性。
对接受机械取栓的连续性缺血性卒中患者进行回顾性研究，这些患者有可用的ED-ps-mRS和PA-ps-mRS。ED-ps-mRS由主治神经科医生评估，并记录在急诊卒中治疗方案中。PA-ps-mRS通过临床记录中登记的信息进行回顾性评估。收集基线特征和3个月的结局。将卒中前功能状态被急诊科高估的患者（ED ps-mRS≤2且PA-ps-mRS≥3）与正确的低和高ED-ps-mRS组进行比较。
我们纳入了409例患者（中位年龄77岁，50%为女性，中位NIHSS为14）。二分法的ED-ps-mRS和PA-ps-mRS（0-2 vs. 3-5）的一致性在81.4%的患者中被发现（Cohen's kappa = 0.476，p < 0.001）。在69例患者（17%）中发现卒中前功能状态被急诊科高估。与ED-ps-mRS正确较低的患者相比，卒中前功能状态被急诊科高估的患者年龄更大（p < 0.001），糖尿病更常见（p < 0.001），既往有卒中（p = 0.014），且3个月功能独立的情况较少见（p < 0.001）。在高估和正确的高ED-ps-mRS之间，卒中前基线特征未发现差异。
五分之一的患者中二分法的ED-ps-mRS和PA-ps-mRS（0-2 vs. 3-5）存在不一致。卒中前功能状态的高估可能会错误地降低预期实现良好3个月功能结局的患者比例。
