Clinical diagnostic tools for screening of perioperative stroke in general surgery: a systematic review

Abstract

Perioperative stroke is a devastating complication that carries high mortality and functional disability. Unfortunately, residual anaesthesia and analgesia may obscure important warning signs and may lead to a delay in the assessment and treatment of major stroke after surgery. The purpose of this review is to examine the utility of existing stroke scales, for the recognition of perioperative stroke in the general surgical population. A total of 21 stroke scales have been described in the literature. Diagnostic performance was reported in 17 scales. The majority of the stroke scales were designed to evaluate current neurological deficits after an established stroke event. Recent abbreviated stroke test, such as the Face, Arm, Speech Test (FAST), were developed to facilitate stroke identification in the emergency department. Only two stroke scales have been applied in the perioperative setting after cardiac, carotid and neurological surgeries. The modified National Institutes of Health Stroke Scale appears to be useful in detecting new subtle neurological deficits in critical care, or high dependency units after surgery. However, in the general postsurgical wards, given the concern about the workload required, abbreviated stroke tests may be more appropriate for routine regular stroke surveillance. It is hoped that these tests will provide rapid assessment of global neurological function to facilitate timely diagnosis and treatment of perioperative stroke.

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Association ofCDKN2B-AS1rs1333049 with Brain Diseases: A Case-control Study and a Meta-analysis

“… 2) The stroke incidence is threefold higher in northern than that in southern Chinese cities, suggesting important environmental or genetic influences. 3) Current studies have affirmed that inherited factor may play a key role in the pathogenesis of HS. 4) Yet the mechanisms of brain diseases are not completely understood.…”

A systematic review and meta-analysis to evaluate the diagnostic accuracy of recognition of stroke in the emergency department (ROSIER) scale

“…During the past decades, several studies have been conducted to validate the diagnostic accuracy of ROSIER in different countries and work settings, but the results were not consistent [12][13][14][15][16][17]. Although previous studies have systematically evaluated its performance [18][19][20][21], the clinical utility and the applicability in other countries, and investigators have not been investigated before. Moreover, another seven studies have not been incorporated in previous meta-analyses [22][23][24][25][26][27][28].…”