Abstract W P186: Usefulness of the New Prehospital Cerebrovascular Disease Triage Score for Patients With Impaired Consciousness by Emergency Medical Services

Abstract

Background and Purpose: Early stroke recognition optimizes patients’ opportunities to benefit from therapeutic options; however, accurate stroke recognition by emergency medical services (EMS) is difficult in patients with impaired consciousness. Here we attempted to establish a new prehospital stroke triage score for such patients. Methods: In 2010, 713 patients (average age, 71 years; 421 men) presenting with impaired consciousness (score of <15 on the Glasgow coma scale) on EMS arrival, who were brought to our hospital, were included. We compared the relation between the symptoms and the vital signs on EMS arrival and the final diagnosis. Results: A final hospital diagnosis of stroke was made for 353 in 713 patients (49.5%). Systolic and diastolic blood pressure (SBP, DBP) on EMS arrival were significantly higher in the stroke group than in the non-stroke group (SBP: 172 mmHg vs 143 mmHg, p < 0.01, DBP: 93 mmHg vs 78 mmHg, p < 0.01). In contrast, the pulse rate (PR) was lower in the stroke group (84 bpm vs 88 bpm, p < 0.05). Receiver operating characteristic analysis showed that the optimum SBP, DBP, and PR cutoffs for stroke were 150 mmHg (sensitivity 76%, specificity 59%), 90 mmHg (63%, 70%), and 90 bpm (70%, 42%), respectively. Using univariate analysis, SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm and an arrhythmia case in addition to new-onset hemiparesis were significantly associated with stroke, whereas a case with cold sweat was not significantly associated. Using multivariable analysis, new onset hemiparesis (Odds ratio 11.0; 95% CI, 5.76-22.7), SBP of >150 mmHg (2.21, 1.26-3.87), DBP of >90 mmHg (2.88, 1.65-5.09), and PR of <90 bpm (2.25, 0.80-3.80) were significantly associated with stroke. The prehospital stroke triage score was calculated for each patient with 1 point assigned to patients with SBP of >150 mmHg, DBP of >90 mmHg, PR of <90 bpm, and 2 points for new onset hemiparesis. The triage score of >2points revealed stroke with relatively high sensitivity and specificity (sensitivity 63%, specificity 87%, AUC = 0.809). Conclusion: The new prehospital stroke triage score was calculated on the basis of vital signs in addition to new onset hemiparesis. This score is very useful for triage of stroke presenting with impaired consciousness.