Kothari Sachin A, Morsi Rami Z, Kozel Olivia A, Baskaran Archit, Sehgal Neha, Verhagen Metman Okker, Desai Harsh, Carrion-Penganos Julian, Thind Sonam, Smith Matthew M, Rana Rohini, Chahine Ahmad, Zakaria Jehad, Karar Lina, Sweid Ahmad, Siegler James E, Coleman Elisheva R, Brorson James R, Mendelson Scott J, Mansour Ali, Prabhakaran Shyam, Kass-Hout Tareq
Department of Neurology, University of Chicago, Chicago, Illinois, USA.
Neurosurgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.
J Neurointerv Surg. 2025 Jan 27. doi: 10.1136/jnis-2024-022309.
Rapid prehospital identification of acute ischemic stroke secondary to large vessel occlusions (AIS-LVO) has been successful in triaging patients, but the use of stroke screening scales often varies. This study aims to compare different stroke screening scales for the detection of anterior and posterior circulation AIS-LVO and AIS secondary to medium vessel occlusions (AIS-MeVO).
We prospectively analyzed stroke alert activations at a comprehensive stroke center between August 1, 2022 and December 31, 2023. We applied eight stroke screening scales (BE-FAST, LAMS, PASS, FAST-ED, EMS RACE, 3-ISS, VAN, and NIHSS) to each stroke alert in the emergency department (ED) and inpatient wards. The final diagnosis was classified as AIS-LVO or AIS-MeVO, AIS without LVO or MeVO, intracranial hemorrhage, transient ischemic attack, or stroke mimic.
A total of 198 patients were analyzed. The mean age was 63.9±15.3 years, 62.1% were female (n=123), and 84.3% were African American/black subjects (n=167). The LAMS scale had a strong performance (area under the curve (AUC) 0.750 (95% CI 0.668 to 0.831)), closely followed by the FAST-ED (AUC 0.736 (95% CI 0.649 to 0.822)) and the VAN (AUC 0.735 (95% CI 0.651 to 0.818)) scales. Cut-off points selected from coordinates of the receiver operating characteristic curves were 3, 3, and a positive VAN, respectively.
This is the first prospective cohort study to compare the performance of eight different screening scales among stroke alerts for detection of AIS-LVO and AIS-MeVO. We found LAMS to be the most discriminative tool, followed by FAST-ED and VAN. However, the findings were non-significant, reinforcing existing retrospective literature that these validated screening scales perform similarly and one is not superior.
院前快速识别继发于大血管闭塞的急性缺血性卒中（AIS-LVO）已成功用于患者分诊，但卒中筛查量表的使用往往存在差异。本研究旨在比较不同的卒中筛查量表对前循环和后循环AIS-LVO以及继发于中血管闭塞的急性缺血性卒中（AIS-MeVO）的检测效果。
我们对2022年8月1日至2023年12月31日期间一家综合卒中中心的卒中警报激活情况进行了前瞻性分析。我们对急诊科（ED）和住院病房的每一次卒中警报应用了八种卒中筛查量表（BE-FAST、LAMS、PASS、FAST-ED、EMS RACE、3-ISS、VAN和NIHSS）。最终诊断分为AIS-LVO或AIS-MeVO、无LVO或MeVO的AIS、颅内出血、短暂性脑缺血发作或疑似卒中。
共分析了198例患者。平均年龄为63.9±15.3岁，62.1%为女性（n = 123），84.3%为非裔美国人/黑人（n = 167）。LAMS量表表现出色（曲线下面积（AUC）为0.750（95%可信区间为0.668至0.831）），紧随其后的是FAST-ED（AUC为0.736（95%可信区间为0.649至0.822））和VAN量表（AUC为0.735（95%可信区间为0.651至0.818））。从受试者工作特征曲线坐标中选择的截断点分别为3、3和VAN阳性。
这是第一项前瞻性队列研究，比较了八种不同筛查量表在卒中警报中对AIS-LVO和AIS-MeVO的检测性能。我们发现LAMS是最具鉴别力的工具，其次是FAST-ED和VAN。然而，这些结果无统计学意义，这强化了现有回顾性文献的观点，即这些经过验证的筛查量表表现相似，没有一种更具优势。
