Are you suffering from a large arterial occlusion? Please raise your arm!

Cooray, C. et al. (2018) Are you suffering from a large arterial occlusion? Please raise your arm! Stroke and Vascular Neurology, 3(4), pp. 215-221. (doi: 10.1136/svn-2018-000165) (PMID:30637127) (PMCID:PMC6312073)

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Background and purpose: Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the predictive value of various models based on National Institutes of Health Stroke Scale (NIHSS) subitems, ranging from simple to more complex models, for predicting large artery occlusion (LAO) in anterior circulation stroke. Methods: Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed. We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions. Using binary logistic regression, we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models. Sensitivities and specificities of the models for predicting LAO were examined. Results: The model with highest predictive value included all NIHSS subitems for predicting LAO (area under the curve (AUC) 0.77), yielding a sensitivity and specificity of 69% and 76%, respectively. The second most predictive model (AUC 0.76) included 4-NIHSS-subitems (level of consciousness commands, gaze, facial and arm motor function) yielding a sensitivity and specificity of 67% and 75%, respectively. The simplest model included only deficits in arm motor-function (AUC 0.72) for predicting LAO, yielding a sensitivity and specificity of 67% and 72%, respectively. Conclusions: Although increasingly more complex models yield a higher discriminative performance for predicting LAO, differences between models are not large. Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status, thereby assisting in triage decisions.

Item Type:Articles
Additional Information:SITS is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet and private donors as well as from an unrestricted sponsorship from Boehringer-Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority and Ferrer Internacional. SITS is currently conducting studies supported by Boehringer-Ingelheim and EVER Pharma as well as in collaboration with Karolinska Institutet, supported by Stryker, Covidien and Phenox. RM has been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR) and by the project FNUSA-ICRC no. CZ.1.05/1.1.00/02.0123 (OP VaVpI). JFS is participant in the Charité Clinical Scientist Program funded by the Charité Universitätsmedizin Berlin and the Berlin Institute of Health.
Glasgow Author(s) Enlighten ID:Abdul-Rahim, Dr Azmil
Authors: Cooray, C., Mazya, M. V., Bottai, M., Scheitz, J. F., Abdul-Rahim, A. H., Moreira, T. P., Mikulik, R., Krajina, A., Nevsimalova, M., Toni, D., Wahlgren, N., and Ahmed, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:Stroke and Vascular Neurology
Publisher:BMJ Publishing Group
ISSN (Online):2059-8696
Published Online:03 September 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Stroke and Vascular Neurology 3(4): 215-221
Publisher Policy:Reproduced under a Creative Commons License

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