Document Type : Short Communication
Authors
1 Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran Department of Epidemiology and Biostatistics, School of Public Health, Alborz University of Medical Sciences, Karaj, Iran
4 Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: We believe that designing a new tool which is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of acute ischemic stroke (AIS) in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis of AIS in the prehospital stage.
Methods: This was a cross-sectional diagnostic accuracy study. All patients transferred to the emergency department (ED) who underwent brain magnetic resonance imaging (MRI) with impression of AIS were evaluated by 9 clinical tools for stroke diagnosis in the pre-hospital phase including Rapid Arterial Occlusion Evaluation (RACE), Cincinnati Prehospital Stroke Scale (CPSS), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Medic Prehospital Assessment for Code Stroke (Med PACS), Ontario Prehospital Stroke Screening Tool (OPSS), PreHospital Ambulance Stroke Test (PreHAST), Recognition of Stroke in the Emergency Room (ROSIER), and Face Arm Speech Test (FAST), and totally 19 items were reviewed and recorded. The new clinical tool was developed based on backward method of multivariable logistic regression analysis. The discrimination power of the new clinical tool for diagnosis of AIS was assessed with the area under the receiver operating characteristic curve (AUC-ROC).
Results: Data from 806 patients were analyzed; of them, 57.4% were men.
The mean age of the study patients was 66.9 years [standard deviation (SD) = 13.9]. In the multivariable model, 8 items remained. The AUC-ROC of the new clinical tool was 0.893 [95% confidence interval (CI): 0.869-0.917], and its best cut-off point was score ≥ 3 for positive AIS. At this cut-off point, sensitivity and specificity were 84.42% and 79.72%, respectively.
Conclusion: We introduced a new nomogram-based clinical tool for the diagnosis of AIS in the prehospital stage, which has acceptable specificity and sensitivity; moreover, it is comparable with previous tools.
Keywords
- Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J. Streamlining of prehospital stroke management: The golden hour. Lancet Neurol 2013; 12(6): 585-96.
- Baratloo A, Forouzanfar Mm, Hashemi B, Saeed S, Kasmaei H, Rouhipour A, et al. Tissue plasminogen activator: A literature review. Arch Neurosci 2016; 3(1): e30452.
- Karimi S, Heydari F, Mirbaha S, Elfil M, Baratloo A. Accuracy of prehospital ambulance stroke test in terms of diagnosis of patients with acute ischemic stroke: A multi-center study. Current J Neurol 2020; 19(4): 196-9.
- Brandler ES, Sharma M, Sinert RH, Levine SR. Prehospital stroke scales in urban environments: A systematic review. Neurology 2014; 82(24): 2241-9.
- Rudd MP, Price CI, Ford GA. Prehospital stroke scales in urban environments: A systematic review. Neurology 2015; 84(9): 962.
- Baratloo A, Mohamadi M, Mohammadi M, Toloui A, Madani Neishaboori A, Rafiei Alavi SN, et al. The value of predictive instruments in the screening of acute stroke: An umbrella review on previous systematic reviews. Front Emerg Med 2022; 6(3): e38.
- Saberian P, Rafiemanesh H, Heydari F, Mirbaha S, Karimi S, Baratloo A. A multicenter diagnostic accuracy study on prehospital stroke screening scales. Arch Iran Med 2021; 24(6): 453-60.
- Purrucker JC, Hametner C, Engelbrecht A, Bruckner T, Popp E, Poli S. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry 2015; 86(9): 1021-8.
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