The Clinical Study Of The Stroke Scales To Predict Large Vessel Occlusion In Acute Ischemic Stroke Patients By DSA

Objective1.To validate the clinical utility of the Cincinnati Prehospital Stroke Severity Scale (CPSSS) in identifying acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) in Chinese population.2. To validate the clinical utility of the Cincinnati Prehospital Stroke Severity Scale (CPSSS) in identifying AIS patients with severe stroke.3.To validate the clinical utility of the Diagnostic of Apoplectic Disease’s Kind of Tranditional Chinese Medicine in identifying AIS patients with LVO.MethodsAll AIS patients from January 1,2013 to December 31,2014 were retrospectively reviewed. We enrolled those patients with symptom onset less than 24 hours and digital subtraction angiography (DSA) record were enrolled in our study. The score of CPSSS、the Diagnostic of Apoplectic Disease’s Kind of Tranditional Chinese Medicine was evaluated according to the National Institutes of Health Stroke Scale (NIHSS) from admission record information. Receiver operating curves, area under the curve, and likelihood ratios were used to evaluate the predictive value for LVO and different severe stroke(a severe stroke defined as NIHSS≥15 and a moderate severity as NIHSS≥10).ResultsOne hundred and forty-one patients were enrolled (76%male, mean age 64 years) in our study. Of them, the median NIHSS score was 8 (0 to 39);the median score of the Diagnostic of Apoplectic Disease’s Kind of Tranditional Chinese Medicine was 10 (0 to 45);the median CPSSS was 0.8 (0 to 4). Large vessel occlusion confirmed by DSA was present in 42 (30%) of 141 patients.In the univariate logistic regression analysis, the odds ratio for AIS patients persisting LVOs increased significantly as the CPSSS score increase (1:OR=2.8,95%CI:1.0～8.4, P=0.059;2:OR=9.5,95%CI:3.4～26.7, P＜0.001; 3:OR=12.2,95%CI:1.0～144.8, P=0.048; 4:OR=42.6,95%CI:4.8～377.6, P=0.001). In the univariate logistic regression analysis of the items of CPSSS, it shows that odds ratios for AIS patients persisting LVOs were increased for conjugate gaze deviation, consciousness and motor weakness (gaze deviation:OR=10.0, 95%CI:2.6～38.6, P=0.001; consciousness:OR=8.8,95%CI:3.7～21.0, P＜0.001; motor weakness:OR=5.9,95%CI:2.7～13.0,P＜0.001).Receiver operating curves showed an acceptable capacity to predict LVO of the CPSSS scale with an area under the curve 0.77(95%CI:0.68～0.85). Score ≥1 had sensitive 62% and specific 73%, positive likelihood ratio 2.72, negative likelihood ratio 0.39 for detecting LVO. Score≥1 was 97%sensitive and 79%specific in identifying NIHSS≥10 and 100%sensitive and 74%specific in identifying NIHSS≥15.Receiver operating curves showed an acceptable capacity to predict LVO of the Diagnostic of Apoplectic Disease’s Kind of Tranditional Chinese Medicine scale with an area under the curve 0.76(95%CI:0.68～0.85). Score≥ 9 had sensitive 60%and specific 85%, positive likelihood ratio 3.93, negative likelihood ratio 0.48 for detecting LVO.ConclusionThe CPSSS scale is a simple tool that may be useful to identify patients with acute ischemic stroke with LVO and the severe stroke in the pre-hospital setting in Chinese acute ischemic stroke population. The Diagnostic of Apoplectic Disease’s Kind of Tranditional Chinese Medicine scale has acceptable sensitivity and hight specifity in identifying LVO. Prospective clinical study was needed to evaluat to demonstrate clinical use.