A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

Saberian, Peyman; Rafiemanesh, Hosein; Heydari, Farhad; Mirbaha, Sahar; Karimi, Somayeh; Baratloo, Alireza

doi:10.34172/aim.2021.65

Cited by 5 publications

(7 citation statements)

References 28 publications

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“…We recently evaluated the accuracy of previous known clinical tools with the same gold standard for the final diagnosis of AIS, as we used here in this study. 7 To reduce the interpretation bias, we made our discussion based on the findings of our previous survey, and compared the characteristics of the new tool with previous ones. At the best cut-off point, the new clinical tool had 89.3% accuracy.…”

Section: Discussionmentioning

confidence: 99%

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A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

Baratloo

Ramezani

Rafiemanesh

et al. 2023

CJN

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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.

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Section: Discussionmentioning

confidence: 99%

“…This finding revealed higher accuracy of the new tool than that of all other clinical tools in our previous study. 7 …”

Section: Discussionmentioning

confidence: 99%

A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

Baratloo

Ramezani

Rafiemanesh

et al. 2023

CJN

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“…In the latest comparative study, Alijanpour et al [ 24 ] compared the sensitivity and specificity of six scales: FAST, CPSS, LAPSS, Los Angeles Motor Scale (LAMS), and The Finnish Pre-hospital Stroke Scale (FPSS), and failed to find which scale is better for early identification of stroke. So did Saberian [ 25 ]. Therefore, the available evidence does not prove which tool is more suitable yet.…”

Section: Discussionmentioning

confidence: 99%

Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project

Bao

Zhang

Hao

et al. 2022

Emergency Medicine International

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Background. There are a large number of stroke patients in China, and there is currently a lack of prehospital acute stroke care training programs. Aim. To develop a prehospital emergency medical service (PEMS) training program to improve the prehospital identification and acute care of acute stroke. Methods. Forty prehospital emergency doctors whose service stations are located within a 10 km radius from Shanghai Pudong New Area Medical Emergency Service Center took this course on November 13, 2014. A questionnaire was designed to evaluate the PEMS personnel’s knowledge in stroke and acute stroke care and was conducted before and after training as an assessment of the effectiveness of training. The patient population in this study included a baseline cohort before training and a prospective cohort after training, each composed of patients who were sent to Shanghai East Hospital South Stoke Center within one year. The transit time, final diagnosis, administration of thrombolysis, and door-to-needle time (DNT) were collected and analyzed. Results. After the training, 100% of the PEMS personnel were competent to identify stroke cases using the Cincinnati prehospital stroke scale (CPSS). All participants realized that intravenous thrombolysis therapy in a time-sensitive manner is the most effective way to treat acute ischemic stroke. Although there was no difference in first-aid transit time before and after training, the stroke diagnosis rate improved by 6.5% after training P = 0.03 . The thrombolysis rate increased to 29.6% from 24.3% but did not reach statistical significance. Compared to 84.0 minutes (standard deviation: 23.1 minutes) before the training, the average DNT after training was 53 minutes (standard deviation: 15.0 minutes), demonstrating a remarkable reduction P < 0.01 . Conclusion. The training program effectively improved the PEMS personnel’s knowledge in stroke and stroke acute care.

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“…One of the most important measures was the reduction of wasting time both at the pre-hospital phase and also after admission to the emergency department (ED) [ 10 , 11 ]. Several stroke screening tools have been designed in this regard that can accurately predict stroke [ 11 ], that mostly applied in prehospital setting and their performance has been rarely evaluated in ED environment. Rapid Arterial oCclusion Evaluation (RACE) scale is one of such tools that designed by Pérez de la Ossa et al not only for screening the stroke cases, but also to differentiate large vessel occlusion (LVO) cases than the others [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, various interventions have been considered and applied by health care systems during the last decades to reduce the time between AIS onset and starting an appropriate management [7][8][9]. One of the most important measures was the reduction of wasting time both at the pre-hospital phase and also after admission to the emergency department (ED) [10,11]. Several stroke screening tools have been designed in this regard that can accurately predict stroke [11], that mostly applied in prehospital setting and their performance has been rarely evaluated in ED environment.…”

Section: Introductionmentioning

confidence: 99%

The Rapid Arterial oCclusion Evaluation (RACE) scale accuracy for diagnosis of acute ischemic stroke in emergency department – A multicenter study

Rafiemanesh,

Barikro,

Karimi

et al. 2023

BMC Emerg Med

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Objective It seems that the available data on performance of the Rapid Arterial oCclusion Evaluation (RACE) as a prehospital stroke scale for differentiating all AIS cases, not only large vessel occlusion (LVO), from the stroke mimics is lacking. As a result, we intend to evaluate the accuracy of the RACE criteria in diagnosing of AIS in patients transferred to the emergency department (ED). Method The present study was a diagnostic accuracy cross-sectional study during 2021 in Iran. The study population consist of all suspected acute ischemic stroke (AIS) patients who transferred to the ED by emergency medical services (EMS). A 3-part checklist consisting of the basic and demographic information of the patients, items related to the RACE scale, and the final diagnosis of the patients based on interpretation of patients’ brain MRI was used for data collection. All data were entered in Stata 14 software. We used the ROC analysis to evaluate the diagnostic power of the test. Result In this study, data from 805 patients with the mean age of 66.9 ± 13.9 years were studied of whom 57.5% were males. Of all the patients suspected of stroke who transferred to the ED, 562 (69.8%) had a definite final diagnosis of AIS. The sensitivity and specificity of the RACE scale for the recommended cut-off point (score ≥ 5) were 50.18% and 92.18%, respectively. According to the Youden J index, the best cut-off point for this tool for differentiating AIS cases was a score > 2, at which sensitivity and specificity were 74.73% and 87.65%, respectively. Conclusion It seems that, the RACE scale is an accurate diagnostic tool to detect and screen AIS patients in ED, Of course, not at the previously suggested cut-off point (score ≥ 5), but at the score > 2.

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A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

Cited by 5 publications

References 28 publications

A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

Improving the Prehospital Identification and Acute Care of Acute Stroke Patients: A Quality Improvement Project

The Rapid Arterial oCclusion Evaluation (RACE) scale accuracy for diagnosis of acute ischemic stroke in emergency department – A multicenter study

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