Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Martijne H. C. Duvekot; Esmee Venema; Hester F. Lingsma; Jonathan M. Coutinho; H. Bart van der Worp; Jeannette Hofmeijer; Reinoud P. H. Bokkers; Adriaan C. G. M. van Es; Aad van der Lugt; Henk Kerkhoff; Diederik W. J. Dippel; Bob Roozenbeek; MR CLEAN Registry Investigators; Linda Postma - Jacobi; Robert Jan van Oostenbrugge; Wim van Zwam; Robert-Jan Goldhoorn

doi:10.1177/23969873211015861

Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

Martijne H. C. Duvekot^*, Esmee Venema, Hester F. Lingsma, Jonathan M. Coutinho, H. Bart van der Worp, Jeannette Hofmeijer, Reinoud P. H. Bokkers, Adriaan C. G. M. van Es, Aad van der Lugt, Henk Kerkhoff, Diederik W. J. Dippel, Bob Roozenbeek, MR CLEAN Registry Investigators, Linda Postma - Jacobi, Robert Jan van Oostenbrugge, Wim van Zwam, Robert-Jan Goldhoorn

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation.

Patients and methods: The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings.

Results: We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001).

Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.

Original language	English
Pages (from-to)	194-204
Number of pages	11
Journal	European Stroke Journal
Volume	6
Issue number	2
DOIs	https://doi.org/10.1177/23969873211015861
Publication status	Published - Jun 2021

Keywords

Stroke
endovascular thrombectomy
prehospital stroke scales
MIDDLE CEREBRAL-ARTERY
ISCHEMIC-STROKE
SUSPECTED STROKE
SEVERITY SCALE
VALIDATION
THROMBECTOMY
DESIGN
THROMBOLYSIS
PREDICTION
TRIAGE

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Cite this

Duvekot, M. H. C., Venema, E., Lingsma, H. F., Coutinho, J. M., van der Worp, H. B., Hofmeijer, J., Bokkers, R. P. H., van Es, A. C. G. M., van der Lugt, A., Kerkhoff, H., Dippel, D. W. J., Roozenbeek, B., MR CLEAN Registry Investigators, Postma - Jacobi, L., van Oostenbrugge, R. J., van Zwam, W., & Goldhoorn, R.-J. (2021). Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations. European Stroke Journal, 6(2), 194-204. https://doi.org/10.1177/23969873211015861

@article{56e6eb31bfdd4f30b7991dbe64f7ea29,

title = "Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations",

abstract = "Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation.Patients and methods: The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings.Results: We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001).Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.",

keywords = "Stroke, endovascular thrombectomy, prehospital stroke scales, MIDDLE CEREBRAL-ARTERY, ISCHEMIC-STROKE, SUSPECTED STROKE, SEVERITY SCALE, VALIDATION, THROMBECTOMY, DESIGN, THROMBOLYSIS, PREDICTION, TRIAGE",

author = "Duvekot, {Martijne H. C.} and Esmee Venema and Lingsma, {Hester F.} and Coutinho, {Jonathan M.} and {van der Worp}, {H. Bart} and Jeannette Hofmeijer and Bokkers, {Reinoud P. H.} and {van Es}, {Adriaan C. G. M.} and {van der Lugt}, Aad and Henk Kerkhoff and Dippel, {Diederik W. J.} and Bob Roozenbeek and {MR CLEAN Registry Investigators} and {Postma - Jacobi}, Linda and {van Oostenbrugge}, {Robert Jan} and {van Zwam}, Wim and Robert-Jan Goldhoorn",

note = "Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. AvdL reports funding from Stryker. BvdW has received fees for consultation from Bayer, Boehringer Ingelheim, and LivaNova. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie), the Erasmus MC University Medical Center, Academic Medical Center Amsterdam, and the Maastricht University Medical Center. Publisher Copyright: {\textcopyright} European Stroke Organisation 2021.",

year = "2021",

month = jun,

doi = "10.1177/23969873211015861",

language = "English",

volume = "6",

pages = "194--204",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Ltd",

number = "2",

}

Duvekot, MHC, Venema, E, Lingsma, HF, Coutinho, JM, van der Worp, HB, Hofmeijer, J, Bokkers, RPH, van Es, ACGM, van der Lugt, A, Kerkhoff, H, Dippel, DWJ, Roozenbeek, B, MR CLEAN Registry Investigators, Postma - Jacobi, L , van Oostenbrugge, RJ , van Zwam, W & Goldhoorn, R-J 2021, 'Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations', European Stroke Journal, vol. 6, no. 2, pp. 194-204. https://doi.org/10.1177/23969873211015861

TY - JOUR

T1 - Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations

AU - Duvekot, Martijne H. C.

AU - Venema, Esmee

AU - Lingsma, Hester F.

AU - Coutinho, Jonathan M.

AU - van der Worp, H. Bart

AU - Hofmeijer, Jeannette

AU - Bokkers, Reinoud P. H.

AU - van Es, Adriaan C. G. M.

AU - van der Lugt, Aad

AU - Kerkhoff, Henk

AU - Dippel, Diederik W. J.

AU - Roozenbeek, Bob

AU - MR CLEAN Registry Investigators

AU - Postma - Jacobi, Linda

AU - van Oostenbrugge, Robert Jan

AU - van Zwam, Wim

AU - Goldhoorn, Robert-Jan

N1 - Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. AvdL reports funding from Stryker. BvdW has received fees for consultation from Bayer, Boehringer Ingelheim, and LivaNova. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was partly funded by the Applied Scientific Institute for Neuromodulation (Toegepast Wetenschappelijk Instituut voor Neuromodulatie), the Erasmus MC University Medical Center, Academic Medical Center Amsterdam, and the Maastricht University Medical Center. Publisher Copyright: © European Stroke Organisation 2021.

PY - 2021/6

Y1 - 2021/6

N2 - Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation.Patients and methods: The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings.Results: We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001).Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.

AB - Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation.Patients and methods: The MR CLEAN Registry is a prospective, observational study in all centres that perform EVT in the Netherlands. We included adult patients with an anterior circulation stroke treated between March 2014 and November 2017. We used National Institutes of Health Stroke Scale scores at admission to reconstruct previously published prehospital stroke scales. We compared the sensitivity of each scale for different occlusion locations. Occlusions were assessed with CT angiography by an imaging core laboratory blinded to clinical findings.Results: We included 3021 patients for the analysis of 14 scales. All scales had the highest sensitivity to detect internal carotid artery terminus occlusions (ranging from 0.21 to 0.97) and lowest for occlusions of the M2 segment (0.08 to 0.84, p-values < 0.001).Discussion and conclusion: Although prehospital stroke scales are generally sensitive for proximal large vessel occlusions, they are less sensitive to detect more distal occlusions.

KW - Stroke

KW - endovascular thrombectomy

KW - prehospital stroke scales

KW - MIDDLE CEREBRAL-ARTERY

KW - ISCHEMIC-STROKE

KW - SUSPECTED STROKE

KW - SEVERITY SCALE

KW - VALIDATION

KW - THROMBECTOMY

KW - DESIGN

KW - THROMBOLYSIS

KW - PREDICTION

KW - TRIAGE

U2 - 10.1177/23969873211015861

DO - 10.1177/23969873211015861

M3 - Article

C2 - 34414295

SN - 2396-9873

VL - 6

SP - 194

EP - 204

JO - European Stroke Journal

JF - European Stroke Journal

IS - 2

ER -