Presenting symptoms and diagnostic accuracy of prehospital stroke scales for patients with suspected mild minor stroke.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-08-11 DOI:10.1177/23969873251360592

Helge Fagerheim Bugge, Mona Guterud, Karianne Larsen, Mathias Toft, Maren Ranhoff Hov, Else Charlotte Sandset

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引用次数: 0

Abstract

Introduction: Identifying patients with minor stroke is challenging in the prehospital setting due to subtle symptoms. The majority of studies evaluating prehospital stroke scales include patients with high median NIHSS at admission. ParaNASPP, a stepped-wedge cluster-randomized controlled trial found that prehospital NIHSS identified more patients with minor symptoms. Further knowledge on presenting symptoms of patients with suspected minor stroke, and the accuracy of prehospital stroke scales on minor stroke is needed.

Methods: A post-hoc analysis of data from the ParaNASPP trial describes prehospital presenting signs and symptoms of patients with suspected mild minor stroke. We defined mild minor stroke as NIHSS 0-2 at hospital admission. Furthermore, we reconstructed and evaluated nine prehospital stroke scales (NIHSS, FAST/CPSS, BE-FAST, LAPSS, MASS, MedPacs, PreHAST, and sNIHSS-EMS) in patients with mild minor stroke.

Results: Four hundred and thirty-one patients in the ParaNASPP trial had NIHSS 0-2 at hospital admission. Of these, 152 (35%) were discharged from hospital with a stroke diagnosis. When examined by paramedics, stroke patients presented with speech disturbance, facial palsy, and motor weakness in arm or leg, while stroke mimics presented with dizziness, headache, and nausea/vomiting. NIHSS had the highest sensitivity (95%) and lowest specificity (16%), while LAPSS had the lowest sensitivity (42%) and highest specificity (80%) in the patients with suspected mild minor stroke. The remaining scales had sensitivity between 67% and 93%, and specificity between 23% and 67%.

Conclusions: In patients with mild minor stroke, substantial overlap in presentation between stroke and stroke mimics makes triage challenging. Prehospital stroke scales provide either high sensitivity or specificity. Competence and training of paramedics in when and how to use, and interpret, these scales is key for recognizing and correctly triaging stroke patients.The ParaNASPP trial was registered at Clinicaltrials.gov with registration number NCT04137874.

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疑似轻度脑卒中患者院前脑卒中量表的表现及诊断准确性

由于轻微的症状，在院前识别轻度中风患者是具有挑战性的。大多数评估院前卒中量表的研究包括入院时NIHSS中位数较高的患者。ParaNASPP，一项楔形聚类随机对照试验发现院前NIHSS识别出更多有轻微症状的患者。需要进一步了解疑似轻微卒中患者的症状，以及院前卒中量表对轻微卒中的准确性。方法：对来自ParaNASPP试验的数据进行事后分析，描述了疑似轻度中风患者院前出现的体征和症状。我们将轻度脑卒中定义为入院时NIHSS为0-2。此外，我们重建并评估了9种院前卒中量表（NIHSS、FAST/CPSS、BE-FAST、LAPSS、MASS、MedPacs、PreHAST和sNIHSS-EMS）在轻度轻度卒中患者中的应用。结果：在ParaNASPP试验中，431例患者入院时NIHSS为0-2。其中，152人（35%）因中风诊断出院。当医护人员检查时，中风患者表现为语言障碍、面瘫和手臂或腿部运动无力，而中风模拟患者表现为头晕、头痛和恶心/呕吐。在疑似轻度脑卒中患者中，NIHSS的敏感性最高（95%），特异性最低（16%），而LAPSS的敏感性最低（42%），特异性最高（80%）。其余量表的敏感性在67% ~ 93%之间，特异性在23% ~ 67%之间。结论：在轻度脑卒中患者中，脑卒中和脑卒中模拟患者的表现有很大的重叠，这使得分诊具有挑战性。院前卒中量表具有较高的敏感性和特异性。护理人员在何时、如何使用和解释这些量表方面的能力和培训是识别和正确分诊中风患者的关键。ParaNASPP试验已在Clinicaltrials.gov注册，注册号为NCT04137874。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.