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Development of a new stroke scale in an emergency setting

Mao, Haifeng, Lin, Peiyi, Mo, Junrong, Li, Yunmei, Chen, Xiaohui, Rainer, Timothy and Jiang, Huilin 2016. Development of a new stroke scale in an emergency setting. BMC Neurology 16 (1) , 168. 10.1186/s12883-016-0695-z

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Abstract

Background: Early identification of stroke is crucial to maximize early management benefits in emergency departments. This study aimed to develop and validate a new stroke recognition instrument for differentiating acute stroke from stroke mimics in an emergency setting. Methods: A prospective observational cohort study among suspected stroke patients presenting to Emergency Department in the Second Affiliated Hospital of Guangzhou Medical University was conducted from May 2012 to March 2013. The symptoms and signs of suspected stroke patients were collected. Logistic regression analysis was used to identify the factors associated with acute stroke. The symptoms and signs closely associated with acute stroke were selected to develop the new stroke scale, Guangzhou Stroke Scale (GZSS). The diagnostic value of GZSS was then compared with ROSIER, FAST and LAPSS. The primary outcome was confirmed stroke by CT within 24 h. Results: Four hundred and sixteen suspected stroke patients (247 ischemia, 107 hemorrhage, 4 transient ischemic attack, 58 non-stroke) were assessed. A new stroke scale, GZSS (total score from −1 to 8.5), was developed and consisted of nine parameters: vertigo (−1), GCS ≤ 8 (+2), facial paralysis (+1), asymmetric arm weakness (+1), asymmetric leg weakness (+1), speech disturbance (+0.5), visual field defect (+1), systolic blood pressure ≥145 mmHg (+1) and diastolic blood pressure ≥95 mmHg (+1). Among the four scales, the discriminatory value (C-statistic) of GZSS was the best (AUC: 0.871 (p < 0.001) when compared to ROSIER (0.772), LAPSS (0.722) and FAST (0.699). At an optimal cut-off score of >1.5 on a scale from −1 to 8.5, the sensitivity and specificity of GZSS were 83.2 and 74.1 %, whilst the sensitivities and specificities of ROSIER were 77.7 and 70.7 %, FAST were 76.0 and 63.8 %, LAPSS were 56.4 and 87.9 %. Conclusion: GZSS had better sensitivity than existing stroke scales in Chinese patients with suspected stroke. Further studies should be conducted to confirm its effectiveness in the initial differentiation of acute stroke from stroke mimics. Keywords: Diagnosis, Stroke, Stroke mimics, ROSIER scale, FAST scale, LAPSS scale, Emergency department, China Abbreviations: AUC, area under the ROC curve; CT, computed tomography; DWI, diffusion weighted imaging; FAST, the face arm speech test; GCS, Glasgow Coma Scale; IQR, inter quartile range; LAPSS, the Los Angeles Prehospital Stroke Screen; MRI, magnetic resonance imaging; NIHSS, National Institute of Health stroke scale; OR, odds ratio; ROC, receiver operating characteristic; ROSIER, the Recognition of Stroke in the Emergency Room scale; TIA, transient ischemic attack

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RA Public aspects of medicine
Publisher: BioMed Central
ISSN: 1471-2377
Funders: Key Medical Disciplines
Date of First Compliant Deposit: 2 June 2017
Date of Acceptance: 3 September 2016
Last Modified: 18 Jun 2019 15:21
URI: http://orca-mwe.cf.ac.uk/id/eprint/101114

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