Abstract
Background: Screening is a valuable tool for triage, protocol activation, and resource allocation in emergency medicine, yet no tool is identified as superior in the prehospital or hospital setting. DESTINY is a screening tool developed as a single tool to screen for all stroke subtypes. Methods: This study is a phase II prospective 2-part adaptive design validation study of DESTINY in the ED during the early triage of suspected stroke patients from 05/01/2022 to 08/08/2022. CSTAT and VAN were embedded in the tool. DESTINY was incorporated into EHR and standardized workflow for nursing triage in ED. The NIHSS at presentation, primary diagnosis, and stroke subtypes were recorded. Symptomatic was defined as any new neurological deficit. During the blinded phase, only CSTAT score was provided for clinical decisions. Primary outcomes included predictability of DESTINY scores to identify acute symptomatic stroke and LVO. Secondary outcome included stroke performance measures. Score completion failures were retrospectively scored by a vascular neurologist provided with chief complaint and initial exam, blinded to final diagnosis and imaging. Results: During part 1, 284 patients were screened with DESTINY; 92 patients (32%) had score completion failures. Median: NIHSS at initial assessment 2 (mean 4.4; range 0 to 28); door to stroke scale start 6 minutes; door to stroke provider (thrombolytic eligible patients) 10 minutes; door to needle 62 minutes; door to puncture 94 minutes. Acute symptomatic stroke was recorded in 110 including LVO in 19. The DESTINY score with highest predictability for acute symptomatic stroke was > 1 (sensitivity 0.95 [95% CI 90.3-98.8], specificity 0.44 [95% CI 36.9-51.6]) and acute symptomatic LVO was > 3 or > 1 and at least one positive from questions 3 to 7 (sensitivity 1.0, specificity 0.63 [95% CI 56.8-68.5]). Conclusion: DESTINY at defined scores has promise as a single tool to identify patients with acute symptomatic stroke and LVO.
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