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The role of prehospital scales in identifying anterior circulation macrovascular occlusion (aLVO) in patients with suspected stroke may vary
depending on the severity of their presentation.
The performance of these scales at different severity of defects is unclear
.
The objective of this review was to evaluate the diagnostic performance
of eight prehospital scales to identify anencephaly at different defect severity.
Data from the PRESTO study (prehospital shunting of patients with suspected stroke symptoms), a prospective observational study
comparing the detection of LLO in patients with suspected stroke on the Prehospital Stroke Scale.
The NIHSS score of in-hospital assessment was used as a clinical assessment of stroke severity during the prehospital assessment
by nursing staff.
The sensitivity, specificity, positive predictive value, negative predictive value and difference in aLVO probability (ΔPaLVO) for each scale of mild (NIHSS 0-4), moderate (NIHSS 5-9), moderate (NIHSS 10-14), and severe disorder (NIHSS≥15)
were calculated.
Results Among the 1033 patients with suspected stroke, 119 (11.
5%) had LVO, of which 19 (16.
0%) had mild disease, 25 (21.
0%) had moderate disorder, 30 (25.
2%) had moderate and 45 (37.
8%) had severe impairment
.
The scale has low sensitivity and positive predictive value for patients with mild-moderate deficiency and poor
specificity, negative predictive value, and accuracy for moderate-severe deficiency.
In patients with mild defects, positive results for ΔPaLVO were the highest
.
A negative result achieves the highest ΔPaLVVO in the case of severe defects, but the probability of LVO with a negative result in the severe range is higher than that of a test
that is positive in the mild range.
Commonly used prehospital stroke scales show different performance
within the severity of the defect.
In severe patients, the probability of VGO remains high
.
Studies reporting prehospital stroke scale performance should be evaluated
based on the NIHSS distribution of their samples.
References:
Evaluating the Diagnostic Performance of Prehospital Stroke Scales Across the Range of Deficit Severity: Analysis of the Prehospital Triage of Patients With Suspected Stroke Study.
