Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Martijne H.C. Duvekot*, Esmee Venema, MR CLEAN Registry Investigators, Hester F. Lingsma, Jonathan M. Coutinho, H. Bart van der Worp, Jeannette Hofmeijer, Reinoud P.H. Bokkers, Adriaan C.G.M. van Es, Aad van der Lugt, Henk Kerkhoff, Diederik W.J. Dippel, Bob Roozenbeek

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation. Patients and methods: The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings. Results: We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001). Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.

Original languageEnglish
Pages (from-to)194-204
Number of pages11
JournalEuropean Stroke Journal
Volume6
Issue number2
Early online date13 May 2021
DOIs
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. AvdL reports funding from Stryker. BvdW has received fees for consultation from Bayer, Boehringer Ingelheim, and LivaNova.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie), the Erasmus MC University Medical Center, Academic Medical Center Amsterdam, and the Maastricht University Medical Center.

Publisher Copyright:
© European Stroke Organisation 2021.

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