Diagnostic accuracy of the G-FAST score for detecting large vessel occlusion in suspected stroke patients: a systematic review and network meta-analysis.
Jyun-Jhe Wang, Hui-An Lin, Ho-Chang Huang, Yu-Chen Lin, Sheng-Feng Lin
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引用次数: 0
Abstract
Background: Early and accurate detection of large vessel occlusion (LVO) is essential for timely endovascular thrombectomy in acute ischaemic stroke. The Gaze-Face-Arm-Speech-Time (G-FAST) scale has been proposed as a potential prehospital screening tool for LVO than the Cincinnati Prehospital Stroke Scale (CPSS). This study systematically evaluates the diagnostic performance of G-FAST and compares it with CPSS.
Methods: A systematic review and network meta-analysis were conducted. A comprehensive literature search in PubMed, Embase and Scopus was performed up to 31 December 2024. Pooled sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were estimated. Network meta-analysis was used to compare diagnostic performance across G-FAST≥3, CPSS≥2 and CPSS≥3.
Results: 13 studies involving 12 414 patients were eligible for inclusion in the meta-analysis of G-FAST. G-FAST ≥3 demonstrated pooled sensitivity and specificity of 73.3% (95% CI 66.2% to 79.4%) and 74.3% (95% CI 65.3% to 81.6%), respectively, with an AUC of 0.80. In the network meta-analysis (six studies, 7012 participants), CPSS ≥2 showed the highest pooled sensitivity (79.0%, 95% CI 60.4% to 90.3%) and pooled specificity (66.1%, 95% CI 40.6% to 84.7%), whereas CPSS ≥3 demonstrated higher specificity (83.8%, 95% CI 63.6% to 93.9%) but reduced sensitivity (63.4%, 95% CI 40.1% to 81.7%). G-FAST ≥3 showed a more balanced performance between sensitivity (71.6%, 95% CI 51.4% to 85.7%) and specificity (76.4%, 95% CI 53.8% to 90.0%), with a numerically higher specificity than CPSS ≥2. Overall, there were no statistically significant differences in diagnostic performance among the scales.
Conclusions: G-FAST demonstrates moderate diagnostic accuracy for prehospital LVO detection, with performance comparable to traditional scales. Its use provides a feasible alternative for pre-hospital stroke triage, though further large-scale validation is warranted.
背景：早期准确检测大血管闭塞（LVO）对于急性缺血性脑卒中患者及时进行血管内血栓切除术至关重要。与辛辛那提院前卒中量表（CPSS）相比，凝视-面部-手臂-言语时间（G-FAST）量表被认为是一种潜在的LVO院前筛查工具。本研究系统评价了G-FAST的诊断性能，并与CPSS进行了比较。方法：采用系统综述和网络荟萃分析。在PubMed， Embase和Scopus中进行了全面的文献检索，截止到2024年12月31日。估计合并灵敏度、特异性和受试者工作特征曲线下面积。采用网络荟萃分析比较G-FAST≥3、CPSS≥2和CPSS≥3的诊断性能。结果：13项研究包括12414例患者符合纳入G-FAST荟萃分析的条件。G-FAST≥3的合并敏感性和特异性分别为73.3% （95% CI 66.2% ~ 79.4%）和74.3% (95% CI 65.3% ~ 81.6%)， AUC为0.80。在网络荟萃分析（6项研究，7012名受试者）中，CPSS≥2表现出最高的合并敏感性（79.0%,95% CI 60.4%至90.3%）和合并特异性（66.1%,95% CI 40.6%至84.7%），而CPSS≥3表现出更高的特异性（83.8%,95% CI 63.6%至93.9%），但降低了敏感性（63.4%,95% CI 40.1%至81.7%）。G-FAST≥3在敏感性（71.6%,95% CI 51.4%至85.7%）和特异性（76.4%,95% CI 53.8%至90.0%）之间表现出更平衡的表现，其数值特异性高于CPSS≥2。总体而言，各量表在诊断表现上没有统计学上的显著差异。结论：G-FAST对院前LVO检测具有中等的诊断准确性，其性能与传统量表相当。它的使用为院前卒中分诊提供了可行的选择，尽管进一步的大规模验证是必要的。普洛斯彼罗注册号：CRD42023477601。
期刊介绍：
The Emergency Medicine Journal is a leading international journal reporting developments and advances in emergency medicine and acute care. It has relevance to all specialties involved in the management of emergencies in the hospital and prehospital environment. Each issue contains editorials, reviews, original research, evidence based reviews, letters and more.
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