Abstract

ObjectivesThe prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile. Materials and MethodsThis retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs (“Gaze deviation and Paresis Score, GPS”) for the pre-hospital prediction of ELVO. ResultsA positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75–56.53). The positive Likelihood-ratio (LR+) was 29.67, the negative Likelihood ratio (LR−) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001). ConclusionsThe GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.

Highlights

  • The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment

  • In total 288 of the AIS patients (95%) tested positive for gaze deviation and paresis score (GPS) were in the emergent large vessel occluding (ELVO) group and 565 AIS patients (94%) tested negative for GPS were in the non-ELVO group (Fig. 2A)

  • We developed a simple and rapid prehospital score using two symptoms based on the National Institutes of Health Stroke Scale (NIHSS) items, gaze palsy and hemiparesis, to reliably diagnose ELVO in the anterior circulation of AIS patients

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Summary

Introduction

The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Reperfusion modalities using systemic thrombolysis (intravenous tissue plasminogen activator [tPA]) and endovascular stroke therapy (EST) are the only established treatment options for acute ischemic stroke (AIS) [4,5,6] The latter has become essential in the treatment of large vessel occlusions (ELVO) of the anterior circulation [7]. Numerous prehospital stroke scales, including the Cincinnati Prehospital Stroke Severity (CPSS) scale, Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Prehospital Acute Stroke Severity scale (PASS), exist to identify the presence ELVO in AIS patients [12,13,14] These recently published scales utilize simplifications of 3 and more items from the National Institutes of Health Stroke Scale (NIHSS) to optimize prediction of ELVO [15]. Since gaze deviation and hemiparesis are both commonly observed in ELVO AIS patients[16], we analyzed the accuracy of the gaze deviation and paresis score (GPS) as a prehospital predictor for the presence of ELVO in a retrospective study

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