Validated Pre-Hospital Stroke Scales to Predict Large Vessel Occlusion: A Systematic Review

Abstract

<jats:p>Background Occlusions of large cerebral vessels, including the internal carotid artery and middle cerebral artery, result in significant burden of morbidity. Treatment was previously limited to intravenous thrombolysis, however multiple studies have shown significant improvements when patients undergo endovascular clot retrieval. Early identification and triage to centres capable of delivering this is likely to contribute to improved outcomes. This systematic review aims to compare clinical assessment tools and their performance ‘in-field’ to identify usability and reliability to assist pre-hospital providers with identification of this sub-group of stroke patients. MethodsSeveral databases were reviewed to identify studies that have validated large vessel occlusion clinical assessment tools within the pre-hospital environment. Sensitivity, specificity and predictive value were compared along with any biases. Six studies met the study criteria and were included. A total of 1384 patients were involved in the studies with sensitivities ranging from 51.9% to 100% and specificities ranging from 68% to 90%.ConclusionThere is significant variation among studies and the emergency medical systems they have been performed within. It is likely that no single tool will suit every system and further research is required to determine the best tool for the Australian pre-hospital environment.</jats:p>

The Future of Stroke Interventions

“…Observational data have revealed that the more severe the stroke, the greater the likelihood of experiencing an LVO. Several simplified clinical scales have been studied for this purpose, but none of them achieved both high sensitivity and specificity, 17 and to date there is no clear evidence of their value for managing dispatch rules in the field.…”

Prehospital triage of acute stroke patients

“…Cévní mozková příhoda (CMP) patří celosvětově i v České republice mezi nejčastější příčiny úmrtí nebo invalidizace (Loudon et al, 2019). Aktuálně jsou k dispozici pro pacienty s ischemickou CMP dvě základní léčebné modality -intravenózní trombolýza a mechanická trombektomie (MT).…”

New Prehospital Triage for Stroke Patients Significantly Reduces Transport Time of EVT Patients Without Delaying IVT

“…Ischemic stroke is a leading cause of mortality and morbidity worldwide ( 1 ), and the recognition of stroke symptoms and prehospital stroke management represent critical bottlenecks in acute stroke management. The delay from the onset of stroke symptoms to hospital arrival is largely due to delayed activation by the patient/witness or failure of EMS crew to recognize stroke symptoms ( 2 – 4 ).…”