Back to Search Start Over

Clinical prediction of large vessel occlusion in anterior circulation stroke: mission impossible?

Authors :
Monika Bühlmann
Kety Hsieh
Anne Broeg-Morvay
Heinrich Mattle
Marcel Arnold
Simon Jung
Pasquale Mordasini
Jan Gralla
Mirjam Rachel Heldner
Urs Fischer
Source :
Heldner, Mirjam Rachel; Hsieh, Kety Wha-Vei; Broeg-Morvay, Anne; Mordasini, Pasquale; Bühlmann, Monika; Jung, Simon; Arnold, Marcel; Mattle, Heinrich; Gralla, Jan; Fischer, Urs (2016). Clinical prediction of large vessel occlusion in anterior circulation stroke: mission impossible? Journal of neurology, 263(8), pp. 1633-1640. Springer-Medizin-Verlag 10.1007/s00415-016-8180-6
Publication Year :
2016

Abstract

Simple clinical scores to predict large vessel occlusion (LVO) in acute ischemic stroke would be helpful to triage patients in the prehospital phase. We assessed the ability of various combinations of National Institutes of Health Stroke Scale (NIHSS) subitems and published stroke scales (i.e., RACE scale, 3I-SS, sNIHSS-8, sNIHSS-5, sNIHSS-1, mNIHSS, a-NIHSS items profiles A-E, CPSS1, CPSS2, and CPSSS) to predict LVO on CT or MR arteriography in 1085 consecutive patients (39.4 % women, mean age 67.7 years) with anterior circulation strokes within 6 h of symptom onset. 657 patients (61 %) had an occlusion of the internal carotid artery or the M1/M2 segment of the middle cerebral artery. Best cut-off value of the total NIHSS score to predict LVO was 7 (PPV 84.2 %, sensitivity 81.0 %, specificity 76.6 %, NPV 72.4 %, ACC 79.3 %). Receiver operating characteristic curves of various combinations of NIHSS subitems and published scores were equally or less predictive to show LVO than the total NIHSS score. At intersection of sensitivity and specificity curves in all scores, at least 1/5 of patients with LVO were missed. Best odds ratios for LVO among NIHSS subitems were best gaze (9.6, 95 %-CI 6.765-13.632), visual fields (7.0, 95 %-CI 3.981-12.370), motor arms (7.6, 95 %-CI 5.589-10.204), and aphasia/neglect (7.1, 95 %-CI 5.352-9.492). There is a significant correlation between clinical scores based on the NIHSS score and LVO on arteriography. However, if clinically relevant thresholds are applied to the scores, a sizable number of LVOs are missed. Therefore, clinical scores cannot replace vessel imaging.

Details

ISSN :
14321459
Volume :
263
Issue :
8
Database :
OpenAIRE
Journal :
Journal of neurology
Accession number :
edsair.doi.dedup.....5548e499694e61fa422a26b6a2f2863d
Full Text :
https://doi.org/10.1007/s00415-016-8180-6