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Diagnostic accuracy of clinical tools for assessment of acute stroke: a systematic review.
BMC Emergency Medicine ( IF 2.5 ) Pub Date : 2019-09-04 , DOI: 10.1186/s12873-019-0262-1
Daria Antipova 1 , Leila Eadie 1 , Ashish Macaden 2 , Philip Wilson 1
Affiliation  

INTRODUCTION Recanalisation therapy in acute ischaemic stroke is highly time-sensitive, and requires early identification of eligible patients to ensure better outcomes. Thus, a number of clinical assessment tools have been developed and this review examines their diagnostic capabilities. METHODS Diagnostic performance of currently available clinical tools for identification of acute ischaemic and haemorrhagic strokes and stroke mimicking conditions was reviewed. A systematic search of the literature published in 2015-2018 was conducted using PubMed, EMBASE, Scopus and The Cochrane Library. Prehospital and in-hospital studies with a minimum sample size of 300 patients reporting diagnostic accuracy were selected. RESULTS Twenty-five articles were included. Cortical signs (gaze deviation, aphasia and neglect) were shown to be significant indicators of large vessel occlusion (LVO). Sensitivity values for selecting subjects with LVO ranged from 23 to 99% whereas specificity was 24 to 97%. Clinical tools, such as FAST-ED, NIHSS, and RACE incorporating cortical signs as well as motor dysfunction demonstrated the best diagnostic accuracy. Tools for identification of stroke mimics showed sensitivity varying from 44 to 91%, and specificity of 27 to 98% with the best diagnostic performance demonstrated by FABS (90% sensitivity, 91% specificity). Hypertension and younger age predicted intracerebral haemorrhage whereas history of atrial fibrillation and diabetes were associated with ischaemia. There was a variation in approach used to establish the definitive diagnosis. Blinding of the index test assessment was not specified in about 50% of included studies. CONCLUSIONS A wide range of clinical assessment tools for selecting subjects with acute stroke has been developed in recent years. Assessment of both cortical and motor function using RACE, FAST-ED and NIHSS showed the best diagnostic accuracy values for selecting subjects with LVO. There were limited data on clinical tools that can be used to differentiate between acute ischaemia and haemorrhage. Diagnostic accuracy appeared to be modest for distinguishing between acute stroke and stroke mimics with optimal diagnostic performance demonstrated by the FABS tool. Further prehospital research is required to improve the diagnostic utility of clinical assessments with possible application of a two-step clinical assessment or involvement of simple brain imaging, such as transcranial ultrasonography.

中文翻译:

临床工具对急性卒中评估的诊断准确性:系统评价。

引言急性缺血性卒中的再通气治疗对时间高度敏感,需要及早确定合格的患者以确保更好的结局。因此,已经开发了许多临床评估工具,本次审查检查了它们的诊断能力。方法综述了目前可用于识别急性缺血性和出血性中风以及中风模仿条件的临床工具的诊断性能。使用PubMed,EMBASE,Scopus和The Cochrane Library对2015-2018年发表的文献进行了系统的检索。选择院前和院内研究,其最小样本量为300名报告诊断准确性的患者。结果纳入二十五个文章。皮质征象(凝视偏差,失语和忽视)是显示大血管阻塞(LVO)的重要指标。选择LVO的受试者的敏感性值在23%至99%之间,而特异性在24%至97%之间。FAST-ED,NIHSS和RACE等临床工具结合了皮层体征和运动功能障碍,显示出最佳的诊断准确性。用于识别中风模拟物的工具显示出的灵敏度从44%到91%不等,而特异性在27%到98%之间,FABS表现出最佳的诊断性能(灵敏度为90%,特异性为91%)。高血压和较年轻的年龄预示着脑出血,而心房纤颤和糖尿病史则与缺血有关。用于确定诊断的方法有所不同。约有50%的纳入研究未明确指出指标测试评估的盲点。结论近年来,已经开发出多种临床评估工具来选择急性中风患者。使用RACE,FAST-ED和NIHSS对皮层和运动功能的评估显示出选择LVO受试者的最佳诊断准确性值。可用于区分急性缺血和出血的临床工具的数据有限。通过FABS工具展示出最佳的诊断性能,在区分急性中风和中风模拟物方面,诊断准确性似乎不高。可能需要进行两步临床评估或涉及简单的脑成像,因此需要进一步的院前研究以提高临床评估的诊断效用,
更新日期:2019-09-04
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