Lancet sub-journal: Race against time - how to quickly and accurately identify intracranial large vascular thusive stroke?

Every year on October 29th is "The Pawn of the World".
2020 feature film emphasizes that at least one in four people will have a stroke in their lifetime, and our goal is not to be that person.
, commonly known as "stroke," is the world's second leading cause of death after cardiovascular disease (CVD).
the world's highest stroke burden, with a lifetime risk of 39.3 per cent.
stroke has the characteristics of high morbidity, high mortality, high disability rate and high recurrence rate.
, there are 13 million sick people living with the disease in China.
According to the latest China Stroke Report 2019 released by the Chinese Stroke Society in association with the Chinese Center for Disease Control and Prevention, in 2018 alone, the number of stroke deaths in China was 1.57 million, accounting for about one-third of the global stroke deaths, accounting for 22.3% of the total death rate of residents, meaning that one in five people in China died of stroke.
, stroke has become the leading cause of death and disability among adults in our country, as well as the leading cause of premature death and disease burden.
treatment for stroke is going to be as soon as possible, and therefore the international theory that "time is the brain" has been put forward.
currently the most effective method is intravenous thrombosis and intravascular therapy.
venous thrombosis is required to be carried out within 4.5 hours of onset, and the drug is pumped through the veins into the dissolved thrombosis.
vascular treatment is interventional surgery, the use of stents directly remove blood clots in the brain or the narrow blood vessels to open, suitable for patients with large blood vessels closed.
due to the effestive nature of in-vascular therapy, rapid pre-hospital identification of large vascular cystication (LVO) is essential to optimize treatment effectiveness in patients with suspected stroke.
inter-hospital transport is an important cause of delays in in-vascular treatment.
this end, cerebrovascular disease experts from the International PRESTO team conducted a corresponding study on the effectiveness of the pre-hospital scale in evaluating LVO.
results were published in the latest issue of Lancet Neurology.
this is a multi-center, forward-looking, observational cohort study of suspected stroke patients transported by ambulance to one of the eight hospitals in southwestern Netherlands.
suspected stroke is defined as a face-arm-language-time (FAST) test positive.
were admitted to hospital only after the symptoms were more than 6h.
training, health care providers used mobile applications to evaluate eight pre-hospital stroke scales, including RACE, LAMS, C-STAT, G-FAST, PASS, CPSS, CG-FAST, and FAST-PLUS.
results of CTA diagnosis as ischemic stroke, accompanied by clinical diagnosis of precirculation near-end intracranial large vascular tract (aLVO).
accuracy of all scales is based on the NIHSS score and evaluated against AAUC values.
2018.08.23-2019.09.02, a total of 1,039 suspected stroke patients (with a medium age of 72) were assessed and 120 (12%) were diagnosed with aLVO.
, RACE has the highest AAUC (0.83,95% CI 0.79-0.86), followed by G-FAST (0.80) and CG-FAST (0.80) .80), LAMS (0.79), CPSS (0.79), PASS (0.76), C-STAT (0.75) and FAST-PLUS (0.72).
the above scales suggest that the accuracy of LVO is within acceptable limits.
but the researchers also found that results assessed by emergency clinicians using the NIHSS scale were more accurate than the pre-hospital stroke scale, with AUC at 0.86 (95% CI 0.83-0.89).
, the accuracy of pre-hospital stroke scale detection of LVO is better, of which RACE, G-FAST and CG-FAST are the best performing pre-hospital stroke scale.
further research is needed in the future to study how these scales can be used to optimize the treatment of ischemic stroke patients.
: Duvekot MHC, et al. Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study. Lancet Neurol. 2021 Jan 7:S1474-4422(20)30439-7. doi: 10.1016/S1474-4422 (20) 30439-7.MedSci Original Source: MedSci Original Copyright Notice: All noted on this website "Source: The text, images and audio and video materials of Metz Medicine or Source: MedSci Originals are owned by Metz Medicine and may not be reproduced by any media, website or individual without authorization, and shall be reproduced with the words "Source: Mets Medicine".
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