Objectives

The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile.

Materials and Methods

This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs (“Gaze deviation and Paresis Score, GPS”) for the pre-hospital prediction of ELVO.

Results

A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75–56.53). The positive Likelihood-ratio (LR⁺) was 29.67, the negative Likelihood ratio (LR⁻) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001).

Conclusions

The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.

中文翻译：

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凝视偏差和麻痹分数（GPS）充分预测了发生中风的大血管阻塞

目标

急性缺血性卒中（AIS）患者的预后基本上取决于及时诊断和适当治疗。事实证明，血管内卒中治疗（EST）在治疗前循环中出现的大血管闭塞（ELVO）中风方面非常有效。为了实现及时诊断，值得将少数几个简单的迹象强有力地结合起来，以在院前分诊中由医护人员识别AIS患者中的ELVO。

材料和方法

这项回顾性单中心研究纳入了2010年至2015年之间在三级卒中中心收治的904例AIS患者（324例ELVO，580例非ELVO）。我们根据NIHSS项目重新评估了两种症状，即四肢的凝视偏差和偏瘫（“凝视偏差和轻瘫评分，GPS”），用于院前预测ELVO。

结果

GPS AIS阳性患者预测ELVO的敏感性为0.89，特异性= 0.97，阳性预测值（PPV）= 0.95，阴性预测值（NPV）= 0.94，诊断比值比（DOR）= 34.25（CI：20.75–56.53 ）。阳性似然比（LR ⁺）为29.67，阴性似然比（LR ^-）0.11。GPS阳性（凝视麻痹NIHSS≥0，运动臂NIHSS≥2和运动腿NIHSS≥2）的患者的NIHSS显着高于阴性GPS患者（p <0.001）。

结论

事实证明，GPS在检测AIS患者前循环中的ELVO方面具有类似的准确性，并且比其他已发表的临床评分更具有特异性。它的简单性和清晰度可能使非神经科医务人员能够在临床前环境中高度确定ELVO AIS患者。