Rapid Identification of Patients Eligible for Direct Emergent Computed Tomography Angiography during Acute Ischemic Stroke: The DARE-PACE Assessment.

Giou-Teng Yiang,Pei-Ya Chen,Cheng-Lun Hsiao,Shinn-Kuang Lin,Yun-Hao Chen

doi:10.3390/diagnostics12020511

Giou-Teng Yiang, Pei-Ya Chen + Show 3 more

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https://doi.org/10.3390/diagnostics12020511

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Journal: Diagnostics	Publication Date: Feb 16, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: Taipei Tzu Chi Hospital, Tzu Chi University

Abstract

Background: We investigated the clinical signs to establish a method for rapid identification of patients with the National Institute of Health Stroke Scale (NIHSS) score ≥ 8 eligible for direct brain CTA study; Methods: We retrospectively enrolled 2895 in patients with acute ischemic stroke (AIS). Four items in the NIHSS were selected as the main clinical signs of stroke; Results: A total of 922 (31.8%) patients had an initial NIHSS score of ≥8. The average door-to-CT time and door-to-CTA time were 13.4 ± 1.8 and 75.5 ± 44.5 min, respectively. Among 658 patients who had the priority signs, namely dense hemiplegia (D), aphasia with right arm drop (AR), and eyeball forced deviation (E), 634 patients (96.4%) with an NIHSS score ≥ 8 were identified. By using a classification and regression tree analysis, 153 patients with an NIHSS ≥ 8 were identified among 175 patients (87.4%) who had the secondary signs, namely hemiparesis with limb falls (P), aphasia (A), drowsy or worse consciousness (C), and eyeball limitation (E). The sensitivity, specificity, and accuracy were 85.4%, 97.7%, and 95.3%, respectively. Conclusions: The DARE-PACE assessment involving a checkbox list provides excellent accuracy for rapid identification of AIS patients with an NIHSS score ≥ 8 for direct CTA study to reduce the time delay for endovascular thrombectomy.

Highlights

Accepted: 14 February 2022Intravenous thrombolysis (IVT) is the most effective pharmacological treatment in the hyperacute stage to improve outcomes of patients with ischemic stroke [1]
After screening out 658 patients with priority signs, 288 patients with an National Institute of Health Stroke Scale (NIHSS) score ≥ 8 remained among the 2237 patients
We translated the cutoff values of each item into secondary simple signs, namely drowsy or worse consciousness (C), hemiparesis with limb falls (P; rapid arm or leg falls from raised position; some effort against gravity), any type of aphasia (A), and eyeball limitation (E)

Summary

Introduction

Intravenous thrombolysis (IVT) is the most effective pharmacological treatment in the hyperacute stage to improve outcomes of patients with ischemic stroke [1]. Endovascular thrombectomy (EVT) is a direct intra-arterial approach to removing the thrombus in the occluded artery and enables complete patency of the artery with effective recanalization [2]. The efficacy of IVT and EVT decreases with time elapsed from symptom onset. The recommended therapeutic time window is within 3–4.5 h for IVT and within 6 h for initiation of EVT in anterior circulation large vessel occlusion (LVO) after symptom onset [3,4,5]. Most studies have found that bridging therapy, combining IVT and subsequent. The current American and European guidelines recommend IVT therapy for patients with LVO before EVT [4,8]

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