Background and Purpose—The prehospital setting is a promising site for therapeutic intervention in stroke, but current stroke screening tools do not account for the evolution of neurological symptoms in this early period. We developed and validated the Paramedic Global Impression of Change (PGIC) Scale in a large, prospective, randomized trial.Methods—In the prehospital FAST-MAG (Field Administration of Stroke Therapy-Magnesium) randomized trial conducted from 2005 to 2013, EMS providers were asked to complete the PGIC Scale (5-point Likert scale values: 1-much improved, 2-mildly improved, 3-unchanged, 4-mildly worsened, 5-much worsened) for neurological symptom change during transport for consecutive patients transported by ambulance within 2 hours of onset. We analyzed PGIC concurrent validity (compared with change in Glasgow Coma Scale, Los Angeles Motor Scale), convergent validity (compared with National Institutes of Health Stroke Scale severity measure performed in the emergency department), and predictive validity (of neurological deterioration after hospital arrival and of final 90-day functional outcome). We used PGIC to characterize differential prehospital course among stroke subtypes.Results—Paramedics completed the PGIC in 1691 of 1700 subjects (99.5%), among whom 635 (37.5%) had neurological deficit evolution (32% improvement, 5.5% worsening) during a median prehospital care period of 33 (IQR, 27–39) minutes. Improvement was associated with diagnosis of cerebral ischemia rather than intracranial hemorrhage, milder stroke deficits on emergency department arrival, and more frequent nondisabled and independent 3-month outcomes. Conversely, worsening on the PGIC was associated with intracranial hemorrhage, more severe neurological deficits on emergency department arrival, more frequent treatment with thrombolytic therapy, and poor disability outcome at 3 months.Conclusions—The PGIC scale is a simple, validated measure of prehospital patient course that has the potential to provide information useful to emergency department decision-making.Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT00059332.

中文翻译：

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护理人员对急性卒中的院前评估和运输过程中变化的总体印象。

背景和目的-院前环境是治疗中风的有前途的场所，但是当前的中风筛查工具并未考虑早期阶段神经系统症状的演变。我们在一项大型的前瞻性随机试验中开发并验证了医护人员对变化的整体印象（PGIC）量表。方法—在2005年至2013年进行的院前FAST-MAG（卒中治疗-镁现场管理）随机试验中，EMS提供者被要求完成PGIC量表（5点李克特量表的值：连续1例患者在运输过程中神经症状改变的1分改善，2分改善，3分不变，4分恶化，5分恶化）发病2小时内有救护车。我们分析了PGIC并发有效性（与格拉斯哥昏迷量表的变化，洛杉矶运动量表），收敛效度（与美国国立卫生研究院卒中量表在急诊室进行的严重程度测量相比）和预测效度（到院后神经功能恶化以及最终90天的功能结局）。结果—医务人员在1700名受试者中的1691名患者中完成了PGIC（99.5％），其中635名（37.5％）的神经功能缺损演变了（32％改善，5.5％恶化）。住院前中位护理时间为33分钟（IQR，27-39）。改善与脑缺血而非颅内出血的诊断，急诊科到达时轻度脑卒中缺陷以及更频繁的非残障和独立3个月预后有关。反过来，PGIC恶化与颅内出血，急诊科到达时出现更严重的神经功能缺损，溶栓治疗更频繁的治疗以及3个月的残障结果相关。结论— PGIC量表是一项简单有效的院前患者病程测量方法，有潜力提供对急诊部门的决策有用的信息。注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT00059332。经过验证的院前患者病历测量方法，有可能为急诊科的决策提供有用的信息。注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT00059332。经过验证的院前患者病历测量方法，有可能为急诊科的决策提供有用的信息。注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT00059332。