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<p>Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH). Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO. We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients. Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50–8.43), GCS &lt; 8 (OR 8.19; 3.17–21.13), SBP &gt; 160mmHg (OR 6.43; 3.37–12.26) and male sex (OR 2.07; 1.13–3.80) were associated with ICH, while previous hypercholesterolemia (OR 0.35; 0.19–0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP &gt; 160, + 1 points for headache, + 1 points for male sex, + 2 points for GCS &lt; 8, and − 1 points for HCL. The area under the curve was 0.82 (0.77–0.87). A score ≥ 4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98. We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting. </p>

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Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月23日

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  • A. Freixa-Cruz,
  • G. Jimenez-Jimenez,
  • G. Mauri-Capdevila,
  • Y. Gallego-Sánchez,
  • A. García-Díaz,
  • R. Mitjana-Penella,
  • M. Paul-Arias,
  • C. Pereira-Priego,
  • E. Ruiz-Fernández,
  • S. Salvany-Montserrat,
  • A. Sancho-Saldaña,
  • E. San-Pedro-Murillo,
  • E. Saureu,
  • D. Vázquez-Justes,
  • Francisco Purroy

摘要

Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH). Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO. We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients. Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50–8.43), GCS < 8 (OR 8.19; 3.17–21.13), SBP > 160mmHg (OR 6.43; 3.37–12.26) and male sex (OR 2.07; 1.13–3.80) were associated with ICH, while previous hypercholesterolemia (OR 0.35; 0.19–0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, + 1 points for headache, + 1 points for male sex, + 2 points for GCS < 8, and − 1 points for HCL. The area under the curve was 0.82 (0.77–0.87). A score ≥ 4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98. We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting.